820577_INSPECTIONS_20171231

NQRTH CARULINA
Department of Environmental Qual

Pee
Date of Visit-,U 0 b Arrival Time: J S Departure Time:
'#-{-�')-'�-' County: Region: e
Farm Name:1 �r�lo k XOwner Email:
Owner Name: ILL,� �. r�v`i� j �Y✓�C Phone:
Mailing Address:
Physical Address:
Facility Contact: Cltl ,' � 15 Title: Phone:
Onsite Representative: h Integrator: 11� io I `a cl .f
Certified Operator: p 0 A. � of G Certification Number: I �� -7
Back-up Operator: Certification Number:
Location of Farm:
Wean to Finish
Laye
n-
-
Wean to Feeder 1rt
Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
D.
Farrow to Finish
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
Lave:
lets
Other I 1 101 (Other
Latitude:
Poults
Discharges and Stream Imuacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
Longitude:
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Be. -f Stocker
Peef Feeder
Beef Brood Cow
❑ Yes L5jM- ❑ NA ❑ NE
❑ Yes ❑ No ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
C3 -DA ❑ 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
C2 -N -A- ❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
�o
❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
.❑ No
❑ NA ❑ NE
of the State other than from a discharge?
Page i of 3 2/4/2015 Continued
ey

Facili Number: jDate of Inspection: 20
Waste allection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [3-t7►_ ❑ 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 43'No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
[] Yes
�o
❑ NA
❑ NE
waste management or closure plan?
❑ Yes
[a'No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
E] Yes
[ ] o
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑.Phi
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NA
❑ NE
acres determination?
❑ Waste Transfers
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[g-N—o
❑ NA
❑ NE
maintenance or improvement?
❑ NA
❑ NE
I& Is there a lack of properly operating waste application equipment?
❑ Yes
Waste Application
❑ NA
�,
-No
10. Are there any required buffers, setbacks, or compliance alternatives that need
ElYes
[]
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes M -Ko ❑ 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 Windowr� ❑ 5 Evidence of Wind Drift ❑ Appli canon Outside of Approved Area
12. Crop Type(s): 1J e.-A-t,jit C.' �it l r i lUl t1 6'✓rte 7 c
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E3 -Wo
❑ NA
❑ NE
13. Soil Type(s): 'AlIff c•¢
❑ Yes
[a'No
❑ NA
❑ NE
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[ZI-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
QNo
❑ NA
❑ NE
acres determination?
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
17. Does the facility lack adequate acreage for land application?
❑ Yes
[3'1Qo
❑ NA
❑ NE
I& 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
E3 -Wo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[a'No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists E] Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[] Yes
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
Q -No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[.]'No
❑ NA
❑ NE
Page 2 of 3 2/42015 Continued

Wacitity Number: jDate of lns ection: -V0
�-
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes U W ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes L_ T o ❑ 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 fust survey indicating non-compliance.
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [a}-ido ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes L2- 1VO ❑ NA ❑ NE
Otber Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31, Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [!`No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes B -5o ❑ NA ❑ NE
❑ Yes Q-56- ❑ NA ❑ NE
❑ Yes ED -NO
❑ Yes [0 No
❑ Yes E�No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
COtYrM6B (refer to gaest%i'"n # Explarn any YES ansrve�rs;andh r'any additional recommends'dons onanyrother�commeiits.
Use deiiwetigsoffactL to better e.. lain' sitnatrons'={ s addrtionald a es' as necfssa
tY _ ap. .. _ p g ry.)
ex tt C-
5 7
�L�j-� 5� 34 7-
3`3
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone)/o-.. s2j 3-- 3_V74
Date:
21412075

L g
—__ Division dfWater�Resources - '"
FaCilltr`i`'umber�71t .r ®, Divistoneitf Soil�aittt�E['ate'r:Consenatton
type of Visit: Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: QTRoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: o—Region:
Farm Name: T V -10 1t 7=F- Owner Email:
Owner Name: LA Phone:
Mailing Address:
Physical Address:
Facility Contact: Ct 3Et.Et(,�Jk`� (( Title:
Onsite Representative: t
Certified Operator: 0 Q V 1A
Back-up Operator:
Location of Farm: Latitude:
Phone:
Integrator: •/
Certification Number: �4
Certification Number:
Longitude:
Discharl 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?
❑ Yes ❑ NA ❑ NE
❑ Yes ❑ No [ A ❑ NE
b. Did the discharge reach waters of the State'? (If yes. notify DWR)
Design Currents
Uestgn Current
L_ 'rNA
Design Cur nt
Swine
C•a act Pa V1 etj Dolt Ca Po
Cattle
Ca achy Pop. f
d_ Does the discharge bypass the waste management system? (If yes, notify DWR)
,"acs
❑ No
SNA
Wean to Finish
I 11-ayer
❑ Yes
Dairy Cow
❑ NA
Wean to Feeder
I jNon-Layer
❑ Yes
Dairy Calf`
❑ NA
Feeder to Finish
Farrow to Wean
�� - - "
"'. C_ urrent
Dairy Heifer
D Cow
D�stgn
Farrow to Feeder
p3DnyiPoitltry
.:Ca acct Po
Non -Dai
Farrow to Finish
_.'
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
- Boars
Pullets
Beef Brood Cow'
Turkeys
Uther
Turkey Poults�_
Other
Other
t
Discharl 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?
❑ Yes ❑ NA ❑ NE
❑ Yes ❑ No [ A ❑ NE
b. Did the discharge reach waters of the State'? (If yes. notify DWR)
[:]Yes
❑ No
L_ 'rNA
❑ 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
SNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
EyNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
allo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of
2/412015 Continued

IFVity Number; ff Date of Inspection: .,, 77
Waste Collection & Treatment ;-�
4* is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ET -go' DNA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [ ,,f4A ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): p
Observed Freeboard (in):
�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Ear o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
[30 o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
eNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
dNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
2rNo
DNA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
0''No
❑ NA
❑ NE
maintenance or improvement?
1 I . Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
dNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN 0 PAN > I0% or 10 lbs- ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window/[] Eviden�ce)o/fWinind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): of y ��?
13. Soil Type(s): &-, NO,
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[3r'N'o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
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 ❑ Desigm ❑Maps 1:1 Lease Agreements
❑ Yesdo
E] Yes No
❑ Yes dNo
❑ Yes 0No
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall D Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22, Did the facility fail to install and maintain a rain gauge? ❑ Yes [� o ❑ NA ❑ NE
23, If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes RNo ❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

Fa ill Number: jDateof Inspection: µ
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 3<o ❑ 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 [4110 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [3<o ❑ NA ❑ NE
r
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes [3 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 Eytalo ❑ 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 [21"No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes EfNo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes [TNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes [!fNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes O No ❑ NA ❑ NE
Comments (refer to question #) Explain any YES.aitsweri-and/orfany additional recommendations. r._any ager eomments , `- ..
Use drawings of facility<to befter`explain situ ationsl(use�addrhonal pa esus necessary).
4 ;:;.11 .. :.:_
sl
- 116%
Reviewer/Inspector Name: N 1 b!"0 040
Phone:110— C -333y
t
Reviewer/Inspector Signature: f�l
Date: �� N
Page 3 of 3
1/4/2015

Type of Visit: Q-C-ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: CrRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ti r Departure Time: r County: a Region:
Farm Name: v
Owner Name:
Mailing Address:
Phvsical Address:
Owner Email:
Phone:
Facility Contact: C.. �C, WQ�.c t✓"tI Title: Phone:
Onsite Representative: It Integrator: of g r `r
Certified Operator: (�Ck Certification Number:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
CS K
Swine
Design Current
Po
Capacityp. Wet Poultry
..::I I-.-,- - "'
Design Current * Design Current .
Ca pactty Eop Cattle= Capacit} Pop.
: aci
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
14 Dairy Calf
Fecder to Finish;
Farrow to Wean
Dairy Heifer
Desi CnrrentZj; Dry Cow
Farrow to Feeder
ltry,
n
ctt ---_;P , Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
; Beef Brood Cow
Qther _
Turkey Poults
Other
Other
_
Discharges and Stream impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: p Structure ❑ Application Field ❑ Other:
❑ Yes Effo-Ro ❑ NA ONE:
a. Was the conveyance man-made? ❑ Yes ❑ No [E3 NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DW R) ❑ Yes ❑ No D -NA ❑ NE
c. What is the estimated volume that reached waters of the State (fal Ions)?
d. Does the discharge bypass the waste management system'? (If yes, notify DWR) ❑ Yes E] No [?'-NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ❑2'No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters 0 Yes [�J_No ❑ NA ❑ NE
of the State other than from a discharge?
Page i of 3 21412015 Continued

Facility' Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus stortn storage plus heavy rainfall) less than adequate? ❑ Yes �0 NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No E3-?tA ❑ 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 [j1 o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes [�rNo ❑ 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 0 No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [0"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 02% ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [7rNo ❑ 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 EDHydraulic Overload [] Frozen Ground ❑ Heavy Mctals (Cu, Zn, etc.)
❑ PAN ❑ PAN 7 100/. 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): C.462C5 Z W` 9&e P/9
—
13. Soil Type(s): e
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 PrNo ❑ 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?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [!fNo
❑ Yes [+] No
❑NA ❑NE
❑ NA ❑ NE
Re uired Records & Documents
No
19. Did the facility tail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[3]
❑ 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.
O WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[E'Flo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soii Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall [:]Stocking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge`?
❑ Yes
E No
❑ NA
E] NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
&No
[] NA
❑ NE
Page 2 of 3 21412015 Continued

FacilltyNumber: Date of Inspection: Pt
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [-bto ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [!'filo ❑ 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 ET< ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [2 -No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [3,*io ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the tirne 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 the 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 CA W M P?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes []"No ❑ NA ❑ NE
❑ Yes [�rlNo ❑ NA ❑ NE
❑ Yes ❑/No ❑ NA ❑ NE
❑ Yes [:�Ao
❑ Yes [4No
[:]Yes dNo
❑ NA ❑ NE
❑ NA ❑ NE
❑NA E] NE
Comments (refer to question #}: Explain any YES answers andlor any additional recommendations or any other comments.
Use drawings of facility to better explain si#uations (use additional paces as necessapy
s
�r V
4S 0 -3
Reviewer/Inspector Name:
Reviewer/Inspector Signatw
Page 3 of 3
Phone: (o 43 3 -��
Date:
2;41015'

Type of Visit: QTompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit- C R utine D Complaint 0 Follow-up Q Referral Q Emergency O Other Q Denied Access
7V
Date of Visit: rrival Time: ' b eparture Time: County: Sf+�& Region:
Farm Name: �� �e Owner Email:
Owner Name: _ 1 ,y�j� .� �G4/vyL S Phone:
Mailing Address:
Physical Address:
Facility Contact: CV,& T L S� f�/�W t �( Title: Phone:
Onsite Representative: Y Integrator: ete
•�''�
Certified Operator: .� V fit; a Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
esign Current
❑ No
Design �mCurrent
' Design Current
11111
Swine apacity Pop.
1111C.,
Wet Poultry
Capacity Popx
Cattle Capacity Pop.
Finish
La er
�. Dai Cow
Feeder S Z
Non -La er
Da Calf
Finish
Da Heifer
Wean
V
Desi n C t
D Cow
Feeder
D . ,P,oal
Ca act `Po ':,"
Non -Dairy
Finish
La ers
Beef Stocker
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
HOther
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)
❑ Yes [Pie— ❑ NA ❑ NE
❑ Yes
❑ No
[3 -NA
❑ NE
[:)Yes
❑No
0 -MA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) [] Yes ❑ No ❑-NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [:]Yes []r5o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters []Yes [-No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2011 Continued

F'ae fify Number: jDate of Inspection:
oll Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
� NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
[] No
21f�-
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure S
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �-r0
S. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
EKo
❑ 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
Niru
❑ 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
[ o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E,1Nb
❑ 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
FTNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[ o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [J bio ❑ NA ❑ NE
❑ Excessive Ponding D Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 tbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind
xDtt
Drift
Application Outside of Approved Area
12. Crop Type(s): aeytAttp�t S56 tJ
13. Soil Type(s): j4t- - J D
14. Do the receiving crops differ from those designated in the CAWMP? 0 Yes QoNo DNA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 3 -'No DNA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Ca'110 ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes D o DNA ❑ NE
❑ Yes []�f4o ❑ 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 CA WMP readily available? If yes, check ❑ Yes [ 0No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes dNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [:]Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield p 120 Minute Inspections 0 Monthly and I " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [5No
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [fNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 2/412014 Continued

Facil1 Number: - Date of Ins ection:
[:]Yes
[!f No
❑ NA
:24. Did the facility fail to calibrate waste application equipment as required by the permit?
[] Yes
[]r5o
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
[Ko
[] NA ❑ NE
the appropriate box(es) below.
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[—]Yes
C&*o
List structure(s) and date of first survey indicating non-compliance:
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
[ q" o
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[]rNo
❑ NA ❑ NE
Other Issues
2$. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes
[!f 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
ONo
❑ 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
C&*o
_[] NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
/ No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond 0 Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Bio
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[ZrINo
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ NA
❑ NE
Comments (refer to question ft Explain any'YES answers and/or any additional recomwei ndii tions or any other coinnnents Use drawings of faciHty to better explain situations (use additional pages as necessary). =15
Reviewer/Inspector Name:
Reviewerllnspector Signature:
Page 3 of 3
t- fLH&
- 3
3 r` o '? ,
Phone: [phone]
Dater � p
2141244

ar
Type of Visit: mom Bance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County:, Region:Q
jj l
Farm Name: �'�I6M,C .-� Owner Email:
Owner Name: 7,� Phone:
Mailing Address:
Physical Address:
Facility Contact: rj,w { S �4y%,[J��"vlitle• Phone:
Onsite Representative: / f integrator:
Certified Operator: 'Sti Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Discharges and Stream Imnacts
1. Is any discharge observed from any part of the operation?
Design Current
�
Design
CurrentDesign
Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Cspadty Pop.
Wean to Finish
ETIIIA
Layer
b. Did the discharge reach waters of the State? (If yes, notify DWR)
I—] Yes
Dai Cow
Wean to Feeder
6 S
[Non -Layer
Dai Calf
Feeder to Finish
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
"' "+
[:]No
NA
Dai Heifer
Farrow to Wean
Farrow to Feeder
=
-D : Poul
Design
Ca aci
Current.
F,o ,
Cow
Non -Dai
Farrow to Finish
[."No
NA
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
TurkeyPoults
Oth er
Other
Discharges and Stream Imnacts
1. Is any discharge observed from any part of the operation?
[3 Yes
�
❑ NA
E3NE
Discharge originated at: ❑ Structure Q Application Field ❑ Other:
a. Was the conveyance man-made?
[—] Yes
[] No
ETIIIA
[] NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
I—] Yes
[:]No
Cg KA
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
f2"I
NA
NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[] Yes
[."No
NA
E] NE
of the State other than from a discharge?
Page I of 3 2/4/2014 Continued

Facili Number: - Date of inspection -;
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes IS'1"o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): r
Observed Freeboard (in): 7 S
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [4-15-o ❑ NA ❑ NE
(i.e. large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes [. 'bio ❑ 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
Wo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ Yes
[Ado
[] NA
❑ NE
9. Does any part of the waste management system other than the waste structures require
❑ Yes
Q2 -No
❑ NA
❑ NE
maintenance or improvement?
Waste Avolication
❑ Yes
[Dim
❑ NA
❑ NE
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
io
❑ NA
❑ NE
maintenance or improvement?
❑ Yes
�,,�
L�'11O
[] NA
❑ NE.
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ®Io ❑ 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): ('1 W t Q
13, Soil Type(s): �K ���td _ I PV b -.
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
GaAlro
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[Ado
[] NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[Pw
[] NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[Dim
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�,,�
L�'11O
[] NA
❑ NE.
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Eala
❑ NA
❑ NE
the appropriate box.
❑ WUP [!]Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
2l. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E04o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes P!(No ❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued

Facility Number: - K %7 Date of Inspection:
Z4. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Q'No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
[] Yes
U i o
❑ NA ❑ NE
the appropriate box(es) below.
El Failure to complete annual sludge survey 0 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
Z2-lq-o
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
E�r<o
❑ 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, aver -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?
Use drawings of facility to better`
G
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
[] Yes L} -<o ❑ NA ❑ NE
[—]Yes NA [] NE
❑ Yes Io �❑ NA ❑ NE
❑ Yes [�o ❑ NA ❑ NE
❑ Yes � No
❑ Yes rD K-0
❑ Yes E;Ko
o
dalm any YES -.answers and/or any. additional recommendations or,atty: oth
ifain situations (use additional pages as necessary).
0-1.7- A-3.1
1z
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Phone: q
3S- Z43 3 �
Date:
21417011

Type of Visit: VXo-mpliance Inspection Q Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit: "utine O Complaint Q Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: r Arrival Time: a eparture Time: CountyRegion: i
Farm Name: Owner Email:
Owner Name: �� Phone:
Mailing Address:
Physical Address:
Facility Contact:C
Vt Title: Phone:
Onsite Representative: f Integrator:
(� ��
Certified Operator: � �A�l `'��6cc U"t Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
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?
0 Yes ff No ❑ NA ❑ NE
❑ Yes ❑ No []-KA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Design Currentit
Design Current
Swine
Capacity Pop.* Wet Poultry
Capacity Pap
Cattle Capacity Pop.
Wean to Finish
La er Dai Cow
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
A
Wean to Feeder
Non -La er
❑ Yes
Dai Calf
Feeder to Finish
❑ NE
_
Dai Heifer
Farrow to Wean
z;�,;
Design rCir�eut
D Cow
Farrow to Feeder
D . P.aultr
Ca acity`Po :_ _
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Boars
- Non -Layers
Pullcts
Beef Feeder
I Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the Operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a_ Was the conveyance man-made?
0 Yes ff No ❑ NA ❑ NE
❑ Yes ❑ No []-KA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
EJAA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[]LA
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
I__Y 0
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 2/412011 Continued

Fac' ' Number: - , Date of lns ection:
"Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes _,�o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
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?
(i.e., large trees, severe erosion, seepage, etc.)
Structure 5 Structure 6
[:]Yes P -No- ❑ NA ❑ NE
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?
14. Do the receiving crops diff from those designated in the CAWMP?
❑ Yes
U>o
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
EVo ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NE
acres determination?
9. Does any part of the waste management system other than the waste structures require
❑ Yes
Q o ❑ NA
❑ NE
maintenance or improvement?
E] No
❑ NA
❑ NE
Waste Application
❑ Yes([�o
❑ NA
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Ejbh1r_ ❑ NA
❑ NE
maintenance or improvement?
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
11, Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Po ❑ 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 D Evidence of Wind Drift E]Application Outside of Approved Area
12. Crop Type(s): _-R' Pt A, S IJy
13. Soi] Type(s):
14. Do the receiving crops diff from those designated in the CAWMP?
❑ Yes
U>o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
allo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[24o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E] No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes([�o
❑ NA
❑ NE
Ree uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[�Vo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
X10
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [—]Yes [ENo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ED Yes �Zo
N ❑ NA C:] NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facili Number: - Date of inspection: s
24' Did the facility fail to calibrate waste application equipment as required by the permitl)V
❑ Yes
Eg No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
�o
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
�To
❑ NA ❑ NE
Other Issues
28. Did the facility fail to property dispose of dead animals with 24 hours and/or document ❑ Yes �o ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ❑ No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes [:]No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes [] No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes ❑ No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawiners of facility to better explain situations (use additional pates as necessary).
-3 0 --G or
3�
Reviewer/Inspector Name: p
Reviewer/Inspector Signature: r V)_I_ ) i Va - Date: [ 0
Page 3 of 3 LOT2/
11

Type of Visit: ®'Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outlne 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
Arrival Time: I IV t3 p 1
Departure Time: J „j
County:
Farm Name -_7'r ; Lt—'�trry4s
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
Owner Email:
DesignCurrent
Current
Owner Name:
Swine Capacity Pap.
Phone:
Capacity Pop.
Cattle Capacity Pop.
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Mailing Address:
Physical Address:
Facility Contact: e �i_ '3a /'w ;Gk Title: tac
Phone:
Region:
Onsite Representative: Integrator: &kT�_
Certified Operator: p� Certification Number: /q$"y37
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
DischarPes and Stream imoaets
1. Is any discharge observed from any part of the operation?
Design
J&No
❑ NA
Design
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
Current
DesignCurrent
Current
a. Was the conveyance man-made?
Swine Capacity Pap.
Wet Poultry
Capacity Pop.
Cattle Capacity Pop.
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
Wean to Finish
Wean to Feeder
Layer
Non -Layer
airy Cow
airy Calf
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
Feeder to Finish
❑ NA
❑ NE
airy Heifer
❑ Yes
Farrow to Wean
❑ NA
1]esign Ci rent
Cow
❑ Yes
Farrow to Feeder
Farrow
Farrow to Finish
D , P,oult .
La ers
Ca- aci P,o p -
Beef Stocker
Gilts
Non -Layers
Beef Feeder
13oars
Pullets
Turkeys
Beef Brood Cow
Other
Other =InOther
Frurkey Poults
DischarPes and Stream imoaets
1. Is any discharge observed from any part of the operation?
❑ Yes
J&No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[]No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
ELNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
ENo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2011 Continued

Facili Number: Date of Inspection: `1
Waste Collection & Treatment
4` 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Oc No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? D Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): a y - 9A 1 Oma' t
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
® No
❑ NA
❑ NE
waste management or closure plan?
[:]NA
❑ NE
[:]Yes
jr'n_-'J' No'
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
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ 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): A# -&*1-W a
13. Soil Type(s):
14. Do the receiving crops differ from those designatfd in the CAWW?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
[:]Yes
C, No
❑ NA
❑ NE
[:]Yes
®No
[:]NA
❑ NE
[:]Yes
jr'n_-'J' No'
[:]NA
❑ NE
D Yes ® No ❑ NA ❑ NE
❑ Yes Q No ❑ NA ❑ NE
❑ Yes W No ❑ NA ❑ NE
[:]Yes KNo ❑ NA ❑ NE
❑ WUP ❑Checklists [] Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0,No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes � No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes J&No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ONE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facility Number:pate of Inspection:
[:]Yes
U? No
❑ NA
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
®No
DNA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
RL Yes
❑ No
❑ NA ❑ NE
the appropriate box(es) below.
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
10 Non-compliant sludge levels in any lagoon
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
Z,No
List structure(s) and date of first survey indicating non-compliance: �Qslhr_ �•r
" �/- �'
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
elf
26. Did the facility fail to provide documentation of an actively certified operator in charge?
[:]Yes
[5No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
® No
❑ NA ❑ NE
Other Issues
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
0 No
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?
❑ NA
❑ NE
29. At the time of the inspection did the facility pose an odor or air quality concern?
[:]Yes
U? No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[:]Yes
23- No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
Z,No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance ofthe permit or CAWMP?
❑ Yes
Z[ No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
0 No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
g No
❑ NA
❑ NE
Comments (refer to question #): Explain -any YES answers and/or any additional recommendations or any other cbmme>its.--
Use drawings of facility to better explain situations (use additional pages as necessary).
/�f� �� • i %� �f�tp�gG p � �" Lia yi � 1 r rx �� (! d ►�`L'G .
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:p3�-33aa
Date: SL3
2/412011

SIMSIQIr)- LTvs
Type of Visit: Compliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: (E Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: D Arrival Time: _Ia-,00 14yol Departure Time:
(cwj
Farm Name: -Tr( RQ tm Owner
Owner Name: T !n Phone:
Mailing Address:
County:Region: FPO
Physical Address: i qQ I C1 r 1, d o l U r_SLfLe pd—
Facility Contact: Aatfick Fi-,,ji plTitle: f"I ffkqf Phone: M -73(o a
Onsite Representative: ilc�fs tiltJS3� 1 i integrator:
Certified Operator: Certification Number: 1 Q$ t(3
r
Sack -up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Impacts
I . Is any discharge observed from any part of the operation?
Desi @urrent-
I
Design Cur_ rent
Des' Current
S
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
Swine.,:
Ca aci Po
P ty P
Wet Poult ,aty
t'Y
bapsc4�
P,op�y
Cattle Capacity Pop.
[—]Yes
QNo
-._... _
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
[:]Yes
❑No
Wean to Finish
❑ NE
Ira er
Da' Cow
Wean to Feeder
❑ Yes
[:]No
Non -La er
ar. I'roWtrV
Desig�t Current
Ca aci 1?0 .
Da' Calf
Da Heifer
D Cow
Non -Dairy
❑ Yes
15 No
Feeder to Finish
❑ NE
Farrow to Wean
Ig Yes
Farrow to Feeder
❑ NA
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Pullets
Beef Feeder
Beef Brood Cow
Boars
NJ
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
I . Is any discharge observed from any part of the operation?
❑ Yes
a No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[—]Yes
QNo
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
[:]Yes
❑No
❑ NA
❑ NE
c, What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
[:]No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
15 No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
Ig Yes
[:]No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 1/4/2011 Continued

Facili Number: 9AX - -72 Date of Inspection:
'�g No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'? ❑ Yes
Waste Collection & Treatment
12 NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'!
❑ Yes
[S 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 S
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
[2VNo
❑ 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
RNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
ONo
❑ 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 D?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
,,o�f Wind Drift ❑ Application Outside of Approved Area
12. Crop TYpe(s): k.Ati ol. gyo Small Gulf! 1 r� e Anneal♦
13. Soil Type(s): Au 'to B � W A _
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 2C No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility tail 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 2[ No
❑ Yes CR No
❑ Yes N[ No
❑ Yes allo
❑ Yes [-No
❑ Yes allo
❑ Other:
❑ NA ❑ NE
❑ NA ❑ NE
E] NA ❑NE
❑NA ❑NE
[] NA ❑ NE
0 N 0 N
21. Does record keeping need improvement'? If yes, check the appropriate box below. ❑ Yes ["No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [] Yes
'�g No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'? ❑ Yes
❑ No
12 NA
❑ NE
Page 2 of 3 21412011 Continued

Facilit Number: $ - 7 Date of inspection:
�24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Ef No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? lfyes, check ❑ Yes e] 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 [g No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [] Yes ❑ No CRNA 0 NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes C' 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 �a No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
X Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes O No [DNA ❑ 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
allo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative'?
❑ Yes
No
❑ NA
❑ NE
34. Docs 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 `any�ottier comments:, G,
x
Use drawings of facrlrtv.to be"tter. explain situations (use additional pages as necessary).
Is, V,elda were UMV i'l a0r) a -j do not Ouffof� nIP4 al n61P,
'jw
.s[vlC- �fi-1.Ojs Mi11"&'alt
}fie s flead,%0ve- abo�+!�g acres wf lvhea+. S{Ze-
Sa*►z (e � la
t, VV 0 (��jF�1 �t ��t'��e. Sv!y Wst1,,S-fitjn -%p bP-
J €^ J 4-hl,Sl ea-
bbabt e 11t,ble
t
au . Ca I's b(a`� ch nod r io be 6)e -fA' y
r
3, T� C0*s have-access`�-o o sm Qil c&ek �� �h+e a, e �j --h kx► �s a -e
Thl S 1S C.L O�enfja lio b if �cvo i s r S /a
p i pP.� , �S � i� 1� e
s `h 01s D be A eId
Naeo,, as- AN Iied 3vrP1 hc,, e nct bp6�j kva�pd c,
t
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
Tom chn-ei p
n
Phone: $0--y 3-330016Lf f
Date: 3, -_)0P
2/4/2011

M-
Faciiity No. Farm Name Trfi% � - Date 4 b
Permit k-✓ COCy OIC_ NPDES (Rainbreaker PLAT Annual Cert )
Rol=
011. R !
La oon
1 2f 3 4 5 6 7
Spillway
..
Design freeboard
Observed freeboard in
Sludge Survey Date
i
Sludge Depth ft
rA
Liquid Trt. Zone ft
7.
Ratio Sludge to Treatment Volume
: 5$
rte+ lv0e1?Fa4 fifli hI1XrrJ ^-a.AMe, 0If(4116 LahI-,;T 1r.,a-17.51 1nr--2_—.n cQ
Calibration Date mt MR
Design Flow
�i-----�-
I' 0�
Soil Test Date Wettable Acres RAIN GAUGE
pH Fields WUP In OF'�ia Dead box or incinerator
Lime Needed Weekly Freeboard✓ 1 �a I Mortality Records
Lime Applied 90(1_- 1 in Inspections 111 -)�, -d,,Q
Cu•I L -Zn -I ✓ 120 min Insp.
Needs P Weather Codes
Cron Yield Transfer Sheets
Waste Analysis Date
.1 r.
.1 r.
. 111
W v
Verify PHONE NUMBEfRS and affiliations
Date last WUP FRO 41 Q 0 ) Date last WUP at farm
FRO or Farm Records
Lagoon # 1`3
Top Dike qq, 0
Stop Pump Q4 +l
Start Pump 14
Conversion- Cu -I 3000= 108 lb/ac; Zn -I 3000= 213 lb/ac
App. Hardware
..
..
rA
�i�-
�/
�g,I '/ r /
I
-...t '1 Iii
.f..I
f 1, •I
W v
Verify PHONE NUMBEfRS and affiliations
Date last WUP FRO 41 Q 0 ) Date last WUP at farm
FRO or Farm Records
Lagoon # 1`3
Top Dike qq, 0
Stop Pump Q4 +l
Start Pump 14
Conversion- Cu -I 3000= 108 lb/ac; Zn -I 3000= 213 lb/ac
App. Hardware

�e,'bhl
YeO a� r
`e, ce
L-0
5
L.
ICIVI
�1
el
L
o
1 pe- 1 °�
90J JOY v.

It ype of visit: D�Luompttance inspection V uperanon Kevtew U,tructure tvatuation U Ieenntcal Assistance
Reason for Visit: Z$ Routine O Complaint O Fallow -up Q Referral O Emergency O Other Q Denied Access
Date of Visit: Arrival Time: j ,pp Departure Time: County:
Farm Name: Owner Email:
Owner Name: I( eho T Pd(m-s Tyr-_ Phone:
Mailing Address:
Physical Address: M-L.Ch-L itr0]' L''I_a _.r U
Region: f r�
Facility Contact: �bft (k Eusse l Title: BEIM kl� Phone: ID-73O.-
D(h Ubcksal -
Onsite Representative: Pt rifIntegrator: Plelldap
Certified Operator: Da,41e- ZTock Sol Certification Number: Icily _q3
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
3'
esign Current
[!�- No
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
Wean to Finish
❑ NE
Layer
Dairy Cow
Wean to Feeder�1
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
Non -La er
❑ No
❑ NA
Dairy Calf
Feeder to Finish
❑ Yes
t'No
❑ NA
❑ NE
Dairy Heifer
Farrow to Wean
C'No
-
Design
Current
Dry Cow
Farrow to FeederDr=
_Poult 9
Ga aei
PgoP .
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
[!�- No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c_ What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
t'No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
C'No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2011 Continued

1~acili , Number: - 7 Date of Ins pection: 9 1 ei
j
W No
Lj NA
Lj NE
Waste Collection & Treatment
❑ Yes
© No
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
5�r 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
❑ NA
Identifier:
18. Is there a lack of properly operating waste application equipment?
❑ Yes
5) No
❑ NA
Spillway?:
Required Records & Documents
Designed Freeboard (in): 19
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
Observed Freeboard (in): 3 -s-
20_ Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
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.)
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
W No
❑ NA
❑ NE
waste management or closure plan?
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
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)
2/4/2011 Continued
9. Does any part of the waste management system other than the waste structures require
❑ Yes
M'No
❑ NA
❑ NE
maintenance or improvement?
_Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
M 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?
Lj Yes
W No
Lj NA
Lj 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
CR No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
t@ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
5) 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. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
SrNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
❑ No
RNA
❑ NE
Page 2 of 3
2/4/2011 Continued

Facility Dumber: Date of Inspection:
® Yes
❑ No
�24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No ❑ NA 2 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.
❑ Yes
® No
❑ Failure to complete annual sludge survey ❑Failure to develop a AOA for sludge
levels
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
JE Non-compliant sludge levels in any lagoon
No
❑ NA
List structure(s) and date of first survey indicating non-compliance: Ldgo&l j-3
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
CR 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
ER 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
N] No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately,
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
® Yes
❑ No
❑ NA
❑ NE
r
❑ Application Field ❑ Lagoon/Storage Pond ® Other: Un
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
O�Z No
❑ NA
❑ NE
Comments (refer to questi":.:Explain any YES answers and/or'any additional recommendations or any'other-corttments.
Use drawings of facility to better explain situations (use additional pages as necessary
c.lft, -kfosh Oj- of ) �jMi 3, Plege_ mgr's {��� co,v� out�de ba)1u
10nnl ` D u Du'�'mOr� + -� e Qs roj 7v$cs (o * wpd—r,
���t amts 4na� `?' �� PC
ca 1 i Wa 0' por4 $r a003 r I { C beck }t' 14)1 0-0"'PJ L I -n -b of P/P.j-1otiye to score
f_twejsarA&e r,er)--ole,.
�SS [ vd9c'_ surueyl 'or aol� i?o�2 '�81'L btu-- ha nth yam{- b wo-� u�
SI ��e is s v F Poir- Jo be_ rpr o� ,p,( by e.►c�L cit a o I J w1J_-hr,,e is a lof of it..,
Cxcpr� ar noq above -J W -el Ims1h6hod **1 ad joftt recardi,
tLars a� pi4� -b ` ma-kf r is o, 4 -
Wd soma I nVio et bow, no -s` c, pfadt-co- corr�.
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
Q
r
Phone: 910—q33• -3.3M(' [t71
Date: aQ
2/4/2011

M
• Facility No. _Farm Name ]41 ie Date 6-0111
Permit "\-/_ COC � OlC^ NPDES (Rainbreaker PLAT Annual Cert)
Pop. Design Current FB
Type Drops
0 "
I.k ,nrm 4 fm 9 1,,-57 1010
Lagoon 2 3 4 5 6 7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date �+
Sludge Depth ft ,
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume ;1.s
p�4,R M
O6 M4 Y/&sem d. , 0.3 CzS�
.r
..
Soil Test Date
Actual
Wettable Acres RAIN GAUGE
Design KIWI
WUP Dead box or incinerator
Lime Needed
.r
..
Soil Test Date
/o
Wettable Acres RAIN GAUGE
pH Fields
WUP Dead box or incinerator
Lime Needed
' a�+�
Weekly Freeboard Mortality Records
Lime Applied
1 in Inspections
Cu -I \/ Zn -I
120 min Insp.
Needs P
Mn
Weather Codes
CroD Yield
lop
Transfer Sheets
.r
..
ml��
Mn
lop
Verify PHONE NUMBERS and affiliations
Date last WUP FRO 5)'1%1q) Date last WUP at farm
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu -I 3000= 108 Ib/ac; Zn -I 3000= 213 Ib/ac
App. Hardware

r-.

,S 2 -2 G -20/4
2 9.46-77
Type of Visit��vmpliance Inspection 0 Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit C7Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency Q Other ❑ Denied Access
Arrival Time: "=/-wO
DateofVisit: 2'Z�/D sos
Farm Name:�j��<-- J �a Vr`^5 Owner Email:
Owner Name: _ � r���t! �' F�w�� � ��- � Phone:
Mailing Address:
Physical Address:
Facility Contact: CAV -41I $G✓„��til✓ Title: _1_1" . Spm • Phone No:
Onsite Representative: Integrator: int e.. ItQ
Certified Operator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: [ o F --T [=A,
Af Longitude: 1=1 o =
Discharges & Stream Impacts
1. Is any discharge observed from any pan of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 2<o ❑ NA ❑ NE
❑ Yes
DesignCurrent
rm
❑ NE
Swine
C+apacity Population
et Popltry Capaculation
Cattle Capacity Population
❑ Wean to Finish
IM Layer
❑ Dairy Cow
Wean to Feeder 7$ I A40WV I/I❑
Non -La er
❑ Dairy Calf
❑ Feeder to Finish
Dry Poultry
❑ Dairy heifer
❑ D Cow
❑ Non -Dai
❑ Farrow to Wean
Yes
[:1I
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turke PouIts ❑ Other
❑ Beef Feeder
❑ Beef Brood Cowl
Plumber ref Structures: a
❑ Boars
LeClOther
Discharges & Stream Impacts
1. Is any discharge observed from any pan 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 2<o ❑ NA ❑ NE
❑ Yes
❑ No
0-9-A
❑ NE
❑ Yes
❑ No
EM
❑ NE
, A
❑ NE
❑ Yes
[:]No
❑ Yes
❑ NA
El NE
Yes
[:1I
�Elivo—
Stvo
❑ NA
❑ NE
12/28/04 Continued

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 Pg<o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ElYes G3 ❑ 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 [3 -No ❑ NA ❑ N E
maintenance or improvement?
Waste ADDlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes EKo ❑ NA ❑ NE
maintenance/improvement? Q
11. Is there evidence of incorrect application? If yes, check the, appropriate box below. ❑ Yes O o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > I0% 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) S -,p owcs,i 1lrW4-V- v��ls, �/�i+�..��. tfC+.�ze_J S'w•cr�G.o:..i f4.S.
13. Soil type(s) A4 /a $ & 14 - —
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑'-No ❑ NA EINE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes �_"go; [:1 NA El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? El3 Yes No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes 2'tcO ❑ NA ❑ NE
❑ Yes 8.140 ❑ NA [IN I -
.Comments (refer t6question #): Explain%any YES -answers and/or any recomtuendattons,or any other ctimuteats.
, Jse, drawings;of facility to better explain situations. (use additional: pages as necessary) y y � `s
Reviewer/Inspector Name%G✓�`.S%1-'--T_-6i s Phone: 4/0• 4133 . 3 -7410
Reviewer/Inspector Signature: Date: 21 -ZI = -_7 0/
12128/04 Continued
Facility Number: 82— .S7 Date of Inspection z -7_s 1D
Waste Collection & Treatment
,_,/
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
,L__TNo�❑
L�'"No ❑ NA
❑ NE
i
Structur 1 Strut 2 Structur Structure 4
Structure
5 Structure 6
Identifier:
Spillway'! --
pillway?:DesignedFreeboard(in):
Designed Freeboard (in):(3�l�fa•."s �,vicvcc.�r✓ec
Observed Freeboard (in): 2Z
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[""No ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
ErNo ❑ 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 Pg<o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ElYes G3 ❑ 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 [3 -No ❑ NA ❑ N E
maintenance or improvement?
Waste ADDlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes EKo ❑ NA ❑ NE
maintenance/improvement? Q
11. Is there evidence of incorrect application? If yes, check the, appropriate box below. ❑ Yes O o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > I0% 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) S -,p owcs,i 1lrW4-V- v��ls, �/�i+�..��. tfC+.�ze_J S'w•cr�G.o:..i f4.S.
13. Soil type(s) A4 /a $ & 14 - —
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑'-No ❑ NA EINE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes �_"go; [:1 NA El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? El3 Yes No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes 2'tcO ❑ NA ❑ NE
❑ Yes 8.140 ❑ NA [IN I -
.Comments (refer t6question #): Explain%any YES -answers and/or any recomtuendattons,or any other ctimuteats.
, Jse, drawings;of facility to better explain situations. (use additional: pages as necessary) y y � `s
Reviewer/Inspector Name%G✓�`.S%1-'--T_-6i s Phone: 4/0• 4133 . 3 -7410
Reviewer/Inspector Signature: Date: 21 -ZI = -_7 0/
12128/04 Continued

Facility Number: BZ -j'7 Date of Inspection Z-zS-i4
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Q'ivo ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists El Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes L71No [:INA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
©'<o
❑ NA
❑ NE
23. If selected, did the facility fait to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[3-<o
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
O<
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
UQ
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
Bo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
P o
❑ NA
❑ NE
Other issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
9 -No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
O—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
EJONo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
0'ITo-
❑ 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
El[
r---����
3<oo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
91110
❑ NA
❑ NE
12/18104

16 -its /0 -07 -zoo?
ivision of Water Quality
Facility NumberS 22M 7 O Division of Soil and Water Conservation
O Other Agency
Type of Visit erleornpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: -Q9 Arrival Time: -Q; S Departure Time: f,00 County:, ��^� Region: )CRO
Farm Name: �0% S Owner Email:
'�' i-Qv� S iNG
Owner Name: `, ' Phone:
Mailing Address:
Physical Address:
Facility Contact: as g 80VWi
LK Title:
D NA
Phone No:
Onsite Representative: CL V-4 s Bay
-W t GV__Integrator:
0 NA
a tia,; � �dt YNR S
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: =0
= =„ Longitude: =()=6
e=6 =
64
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑Wan to Finish ❑ Layer
can to Feeder 7 Q ❑Non -La er
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
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?
Design Current.
Cattle Capacity f opulation`
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
M
❑ Yes ONo ❑ NA ❑ NE
❑ Yes
❑ No
D NA
❑ NE
❑ Yes
❑ No
0 NA
❑ NE
NA
El NE
❑ Yes
No
El Yes
,❑
L'7 No
❑ NA
❑ NE
❑ Yes
EJNo
❑ NA
❑ NE
12/28/04 Continued

Facility Number: 82 — 57 7 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 2<" ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 6,e , e -j 4kl +j — %_Q",cS
5. Are there any immediate threats to the integrity of any of the structures observed? ElYes EIONo ElNA El NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes [2<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 Bogo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes to [:INA ❑ 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 to ❑ NA [:INE
maintenance or improvement?
Waste Application _,�.�
10. Are there any required buffers, setbacks, or Compliance alternatives that need El Yes Li'No ❑ NA ❑ NE
maintenance/improvement?
I I . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 911'o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc_)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑IApplication Outside of Area
12. Crop type(s) Sul%pne V t (dIN4ewr' nn �Urr.,c. dog C � �— ►+mall Greg r.r (D.S
13. Soil type(s) A, AloN
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes E tvo ❑ NA EINE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes EfrNu [_1 NA El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ E'
Yes No ❑ NA [__1 NE
17. Does the facility lack adequate acreage for land application? ❑ Yes ,E]] No [INA [INE
El0
18. Is there a lack of properly operating waste application equipment? Yes 11
0a ❑ NA ❑ NE
Reviewer/InspectorName Phone: 9/p f�33•3
Reviewer/Inspector Signature: Date:
Page 2 of 3 12/28/04 Continued

Facility Number: Z 577 Date of inspection /S—
Reguired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUp ❑ Checklists ❑ Desi s
Design ❑ Maps ❑Other
❑ Yes
L9,<oo
❑ NA
[:1NE
11D Yes
o
❑ NA
❑ NE
21.
Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes
ETNic
❑ NA
❑ NE
❑ Yes
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ NE
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
El NA
N
[:1E
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
.,ff
Ll No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Q N
[INA
[INE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Z
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ENo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[3<o
❑ NA
❑ NE
Other Issues
G 4,V d ►�� �.
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
..
E, No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
ff 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?
El Yes
0
[j NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
B<o
❑ NA
❑ NE
Additional Comments and/or Drawings:
G 4,V d ►�� �.
600ci crop F e_ d_s
]?✓28/04

if
%3.��u s S/z 9/0 6 R -W .-- -
Type of Visit Mompliance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit 0- outlne O Complaint 0 Follow up a Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: %Z_GFj Arrival Time: /O: D Departure Time: //.'/ County: s ADT .Sa✓ Region: /C'deO
Farm Name: % l f—alrwvS Owner Email:
Owner Name:. ,'� � L a �1K 5�, TOVC/ : Phone:
Mailing Address:
Physical Address:
Facility Contact. s Title: l "- . _S G Phone No:
Onsite Representative: -�i1 3 $Q►'W!�t Integrator: Cd g _! e rGt!//til S
Certified Operator -
Back -up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: --) O E_—] ` E:1 " Longitude: = ° =1'
Swine
tg '� rr Desi n Current
Coe acit Po ulatno �t w Design=Current g
p ty p n Wet Poultry Ca. ad Pop U. atian Cattle Capacity Population
❑ Wean to Finish
❑ Layer ❑ Dairy Cow
® Wean to Feeder
g7 Dairy Calf
❑ Feeder to Finish
- 4� ' ❑Dai Heifer
❑ Farrow to Wean`
`
Dry Pauitry "`'" "A El Dry Cow
❑ Farrow to Feeder''`
ElNon-Dairy
❑ Farrow to Finish
El Layers ❑ Beef Stocker
❑ Gilts
❑ Non -Layers ❑ Beef Feeder
❑ Pullets
❑ Boars
❑ Beef Brood Co
NA
❑Turkeys
Other
_ ❑ Turkey Poults
❑ Other
❑ Other Number of Structures: .a
❑ NE
-.. _ b ouilmm
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
El Yes
L7 No
B"
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
NA
[j NE
b. Did the discharge reach waters of the State'? (if yes, notify DWQ)
❑ Yes
❑ No
,.
LSNNAA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
I,/
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
El Yes
No
E<
❑ N1=
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
,,❑_,
Nom❑
NA
[jNE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
,L�f
L�'Na
❑ NA
❑ NE
other than from a discharge?
Page l of 3
12/28/04
Continued

11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
El, -To'[] NA
❑ NE
Facility Number: Date of Inspection S -/Z -OB
Reviewer/Inspector Signature: Date: 9 -/Z -2008
❑ PAN ❑ PAN > 10%or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
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
L'J No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
E(No
L1 No ❑ NA
Spillway?:
17.
Does the facility lack adequate acreage for land application? ❑ Yes
Q<oo ElNA
ElNE
Designed Freeboard (in):
is there a lack of properly operating waste application equipment`? [:1Yes
3 ❑ NA
❑ NE
Observed Freeboard (in): -
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
BIL
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ YeS
01No
❑ 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 threat, notify
DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
D<o
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑Yes
Ergo
[INA
[1 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
I3 <o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
ElD Yes
,�
o
❑ NA
❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
El, -To'[] NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload [] Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
Reviewer/Inspector Signature: Date: 9 -/Z -2008
❑ 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)5. i MWA, Aivmmil . Re4-IK
tlo.s'
13_
Soiltype(s)
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
ErNo ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
El NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
E(No
L1 No ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
Q<oo ElNA
ElNE
18.
is there a lack of properly operating waste application equipment`? [:1Yes
3 ❑ 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):
i
Reviewer/inspector Name j Phone: %10. X33 .3330
Reviewer/Inspector Signature: Date: 9 -/Z -2008
12/28/04 Continued

Facility Number: 52, —,, 7 Date of Inspection
Required_ Records & Documents
l9. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑Yes 9No El NA El NE
20.
Does the facility fail to have all components of the CA WMP readily available? If yes, check
❑ Yes
L7 No
❑ NA
❑ NE
29_
the appropirate box. ❑ NVUp ❑ Checklists ❑ ❑ Maps Design g p El Other
❑ Yes
LT NQ
❑ NA
❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
Coro
❑ NA
❑ NE
30.
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
E o
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
['] 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
[<o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
io
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
91 o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
B o
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CA WMP?
❑ Yes
Q N
❑ NA
❑ NE
29_
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
LT NQ
❑ 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
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
ETNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
El Yes
�,��
L! No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comment;-a,"niilor Drawings r :; 1F`s
Page 3 of 3 12/28/04
Page 3 of 3 12/28/04

G •vim <d 9 - zj?--zctc'f R -k—
Division of Water Quality
Facility Number gZ J % % O Division of Soil and Water Conservation
Q Other Agency
Type of Visit ® Compliance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance:
Reason for Visit ® Routine a Complaint 0 Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: 2]-07 Arrival Time: Departure Time: County: 54�S'OAt/
Farm Name: _ , _c �,�, Yw�.,s_„ , Owner Email:
Owner Name: ,�� • J;xK 14. Phone:
Mailing Address:
Region:
Physical Address:
Facility Contact: �Dly Title: jUir. Phone No:
Onsite Representative: >btJ y .(-,e5_0AJ Integrator:
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0b ❑ ❑ Longitude; =° 04 =It
Swine
Design Current Design Current
Capacity ,Population Wet Poultry, Capacity Population
❑ Wean to Finish I I I Ek=Cf
19 Wean to Feeder Zoo
Feeder to Finish 1215
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑
Turkeys
❑ Turke Poults
❑ Other
Dischar es & 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)
Cattle
Design Current
Capacity Population.
❑ Dairy Cow
❑ Dairy Calf
❑
Dairy Heifet
❑
Dry Cow
❑ Non -Dairy
❑ Beef Stoeket
❑ Beef Feeder
❑ Beef Brood Cowl
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [9 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA
❑ NE
❑ Yes No ❑ NA
❑ NE
❑ Yes No ❑ NA
❑ NE
❑ Yes No ❑ NA
❑ NE
❑ Yes W No ❑ NA
❑ NE
1212$/04 Continued

* Facility Number: — S-7 7
Date of Inspection -27 -07
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?
(ic/ 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 WNo
❑ Yes ® No
Structure 5
❑ NA ❑ NE
0 N El NE
Structure 6
❑ Yes P No ❑ NA ❑ NE
❑ Yes r No ❑ NA ❑ NE
If any of questions 46 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? [] Yes (� No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes�No [:1 NA El NE
maintenance or improvement?
Waste Amnlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
mai ntenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
0 No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
Imo[
ReviewerA nspector Signature: Date: g-7-7-ZOa7
❑ PAN ❑ PAN > 10% or 10 Lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evide//nee of Wind Drift ❑ Application Outside of Area
12.
Crop type(s) Rty W.�kA &_ ra v -O t tJf ti J 5;W11 ilrai4v C O.5,
AVAIL,,&
13.
Soil type(s) �-`� Wp A , W wZ
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
rA No
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
f9 No
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment'? ❑ Yes
RNo
❑ 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):
ReviewerAnspector Namej L �� Phone: q�o�4�33 . 3300
Imo[
ReviewerA nspector Signature: Date: g-7-7-ZOa7
12/28/04 Continued

� V
Facility Number. gZ — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps p ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
[:INA
❑ NE
23_ If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[� No
❑ NA
❑ NE
25,
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWIvIP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31,
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
❑ NA
❑ NE
12/28/04
E

Michael F. Easley, Govemor
Witliam G. Ross Jr., Secretary
North Carolina Depm=ent of Environment and Natural Resources
Coleen H. Sullins, Director
Division of water Quality
July 1, 2007
Triple J Farms,Inc.
Triple
1860 Christmas Tree Road L l L: _'
Dunn, NC 28334
Subject: Certificate of Coverage No. AWS820577
Triple J Farms
Animal Waste Management System
Sampson County
Dear Triple J Farms, Inc.:
In accordance with your application received on January 17, 2007, and request to change from a 2150
feeder -finish plus 7200 wean -feeder operation to a 16875 wean -feeder operation, received on March 13,
2007, we are hereby forwarding to you this Certificate of Coverage (COG) issued to Triple J Farms, Inc.,
authorizing the operation of the subject animal waste management system in accordance with General
Permit AWG100000.
This approval shall consist of the operation of this system including, but not limited to, the management
and land application of animal waste as specified in the facility's Certified Animal Waste Management
Plan (CAWMP) for the Triple J Farms, located in Sampson County, with an animal capacity of no greater
than the following swine annual averages:
Wean to Finish: 0 Feeder to Finish: 0 Boar/Stud: 0
Wean to Feeder: 16875 Farrow to Wean: 0 Gilts: 0
Farrow to Finish: 0 Farrow to Feeder: 0
If this is a Farrow to Wean or Farrow to Feeder operation, there may also be one boar for each 15 sows.
Where boars are unneccessary, they may be replaced by an equivalent number of sows. Any of the sows
may be replaced by gilts at a rate of 4 gilts for every 3 sows.
The COC shall be effective from the date of issuance until September 30, 2009 and replaces the NPDES
COC issued to this facility with an expiration date of July 1, 2007. You are required to continue
conducting annual surveys of sludge accumulation in all lagoons at your facility; the one-year extension
in Condition 111.19 does not apply.
Pursuant to this COC, you are authorized and required to operate the system in conformity with the
conditions and limitations as specified in the General Permit, the facility's CAWMP, and this COC. An
adequate system for collecting and maintaining the required monitoring data and operational information
must be established for this facility. Any increase in waste production greater than the certified design
capacity or increase in number of animals authorized by this COC (as provided above) will require a
modification to the CAWMP and this COC and must be completed prior to actual increase in either
wastewater flow or number of animals.
Please carefully read this COC and the enclosed State General Permit. Enclosed for your convenience is
a package containing the new and revised forms used for record keeping and reporting. Pled
careful attention to the record keeping and monitoring conditions in this permit.
Aquifer Protection Section 1636 Mail Service Center
Internet: www.ncwg=auali!y.ora location: 2728 Capital Boulevard
An Equal OppxtunitylAffinnaWe Action Employer- 50% Rwyciedl10% Post Consumer Paper
N� Carolina
AlaulrdlY
Raleigh, NC 27699-1636 Telephone: [phone]
Raleigh, NC 27604 Fax 1: [phone]
Fax 2: [phone]
Customer Service: [phone]

If your Waste Utilization Plan has been developed based on site-specific information, careful evaluation
of future samples is necessary. Should your records show that the current Waste Utilization Plan is
inaccurate you will need to have a new Waste Utilization Plan developed.
The issuance of this COC does not excuse the Permittee from the obligation to comply with all applicable
laws, rules, standards, and ordinances (local, state, and federal), nor does issuance of a COC to operate
under this permit convey any property rights in either real or personal property.
Upon abandonment or depopulation for a period of four years or more, the Permittee must submit
documentation to the Division demonstrating that all current NRCS standards are met prior to restocking
of the facility.
Per 15A NCAC 02T.01 I l(c) a compliance boundary is provided for the facility and no new water supply
wells shall be constructed within the compliance boundary. Per MRCS standards a 100 -foot separation
shall be maintained between water supply wells and any lagoon, storage pond, or any wetted area of a
spray field.
Per 15A NCAC 02T .1306, any containment basin, such as a lagoon or waste storage structure, shall
continue to be subject to the conditions and requirements of the facility's permit until closed to NRCS
standards and the permit is rescinded by the Division.
Please be advised that any violation of the terms and conditions specified in this COC, the General Permit
or the CAWMP may result in the revocation of this COC, or penalties in accordance with NCGS 143-
215.6A through 143-215.6C including civil penalties, criminal penalties, and injunctive relief.
If you wish to continue the activity permitted under the General Permit after the expiration date of the
General Permit, an application for renewal must be filed at least 180 days prior to expiration.
This COC is not automatically transferable. A name/ownership change application must be submitted to
the Division prior to a name change or change in ownership.
If any parts, requirements, or limitations contained in this COC are unacceptable, you have the right to
apply for an individual permit by contacting the staff member listed below for information on this
process. Unless such a request is made within 30 days, this COC shall be final and binding.
This facility is located in a county covered by our Fayetteville Regional Office. The Regional Office
Aquifer Protection staff may be reached at 910-433-3300. If you need additional information concerning
this COC or the General Permit, please contact the Animal Feeding Operations Unit staff at (919) 733-
3221.
Sincerely,
for Coleen H. Sullins
Enclosures (General Permit AWG 100000, Record Keeping and Reporting Package)
cc: (Certificate of Coverage only for all cc's)
Sampson County Health Department
Sampson County Soil and Water Conservation District
Fayetteville Regional Office, Aquifer Protection Section
AFO Unit Central Files
Permit File AWS820577

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denled Access
Date of Visit: Q$'-Q/-t0(o Arrival Time: 0;.35 Departure Time: County, oN Region:
Farm Name: FOL LIVA 5 Owner Email:
Owner Name: f tr i L -i L 1=a kwt S =N C y Phone:
Mailing Address:
Physical Address:
Facility Contact: 1/O Aj J C, C_ GCSE .j Title. OW -i e.1— Phone No:
Onsite Representative: (1. '-k— 5 & U -I j i r. K. Integrator: C,� �n G 1r i �— F-�G yv S
Certified Operator:
Sack -up Operator:
Operator Certification Number:
Back-up Certification Number:
FP_Q
Location of Farm: Latitude; = a =' = Longitude: = o =' = n
Swine
Diiii esign Current
CapacityPopulation
�-10t �ignCurryyent
s't'et Poultry,CtEpacity P,,opulation
- Design Carrent
Cattle Gagacity Papulation
❑ an to Finish
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
❑ Layer
DaiyCow
Wean to Feeder
7 Z00 I &tq3
Non -Layer
❑ Dairy Calf
Feeder to Finish
Z I❑DaiELHeifei=..r
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑Farrow to Wean
P No
Dry Pottltr_i '
❑ Dry Cow
❑ Farrow to Feeder
"
❑ Non -Dai
❑ Farrow to Finish
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ La ers
❑Beef StoCket
❑ Gilts
❑ NE
❑ Non -La ers
❑ Beef Feeder
❑ Boars
❑ NA
❑ Pullets
❑Beef Brood Co
❑ Yes
[l No
El Turkeys
❑ NE
Other
❑ Other
❑ Turkey Pouits
❑ Other
Number of Structures:
12128/04
Conldnsed
Discharges & Stream Impacts
I . Is any discharge observed from any part of the operation?
❑ Yes
(9 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
[19 No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
P No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
P No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[XI No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
[l No
❑ NA
❑ NE
other than from a discharge?
12128/04
Conldnsed

racility Number: SZ
Date of Inspection 10 S.- 0/'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 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): -(�q
Observed Freeboard (in): 34 //
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 Q� No
❑ Yes [M No
Structure 5
El NA [I NE
El NA [j NE
Structure 6
❑ Yes allo ❑ NA ❑ NE
❑ Yes �KNo ❑ NA ❑ NE
If any of questions 4fi were answered yes, and the situation poses an immediate public stealth or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes CKNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes CgNo ❑ 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 C9 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [9 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. [--]Yes RINo ❑ 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 WindDriftDrift El Application Outside of Area /�
12. Crop type(s) Wi nt be t 5:, .,...�. c — I�NN�t4 1 J3 e -r �► r• .y+c � Z. 5A w // (� rq,'-j
13. Soil type(s) A le- ("Jct sl n., /Va k7 0
14. Do the receiving crops differ from those designated in the CA WMP? ❑ Yes [16 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ()d No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination': ❑ Yes (I No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [31 No ❑ NA ❑ NE
❑ Yes W No ❑ NA ❑ NE
Reviewer/Inspector Name / ut k� �[ $ - Phone: (9/0) y8�- / Sy /
Reviewer/Inspector Signature: Date:yS-- O / ZOp 4?
12/18/04 Continued

Facility Number: Ig —$7 Date of inspection
Required Records _& Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ISNo [:INA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [A No [INA ❑ NE
the appropirate box.
❑ W[JP ❑Checklists C3 Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [9 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes N No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes IN No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[g No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[4No
[:INA
❑ 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
Cl 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
[9No
❑ 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
® No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
09 No
❑ NA
❑ NE
Additional Coaitioeafs,andlor-"Dradviugs'� ��� �`
,• :• u�
12/28/04

0
Type of visit 49 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine Q Complaint Q Follow up O Referral Q Emergency O Other ❑ Denied Access
Date of Visit: }� County: Region • FKc;1
_S� ��ArrivaE Time: � � / I)e acture Time: Coun - +� .fie %�
Farm Name: ZL02111-- V t-cav nn `T Owner Email:
Owner Name:.. 6r Jo J O C- K S p N Phone: fil .- 21Lyi
Mailing Address: r►z asI rc�-__- -� ----_--),�„ ►-.. 1V C-
Physical Address:
Facility Contact: Title:
Onsite Representative: C SS
Certified Operator: Do"
Back-up Operator:
Location of Farm:
Phone No:
Integrator: ca�Nar'� V__
Operator Certification Number:
Back-up Certification Number:
Latitude: =0
=A
longitude: = ° =I =
Design Current Design Current ,
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish ❑ Layer
Wean to Feeder ,Zoo ` i/nt' ❑ Non -La et
O Feeder to Finish—
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other F
Dry Poultry
Non -L
Pullets
Turkey
Poults
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
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
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)?
Number of Structures:�'
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge'?
❑ Yes IV No ❑ NA ❑ NE
(] Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[� No
❑ NA
❑ NE
❑ Yes
[X No
❑ NA
❑ NE
12/28/04 Continued

Ir
Facility Number: —577 Date of Inspection os
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): /JO 1 n 44't r.ft.a4 1 V ,t ; ,r e� v • c 3 .
Observed Freeboard (in): 9,5 �
❑ Yes ® No ❑ NA ❑ NE
[I Yes [-I No [I NA ❑NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes m No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7_ Do any of the structures need maintenance or improvement? ® Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as 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 [9 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) Q� v.-... �� 9 r:& -y erS2: S ►.. e 1 i c i r. - of � C_'. r ,.a Q, v -c i
%A.. .--.
� �. C'1_
W
13. Soil type(s) Au Noy,
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[Id 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
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
(� 1j_5G+''V PiiKG �z..dL rtw�nv� �dG61� SQr
d h � 1 4A, ka
1'4- GV, rcc44 -Cer s:4r,L I S+4 1,,U1,k,
Reviewer/inspector Name �' . L, a .r r 4 ;' e s�` t `' ' � Phone: 9 10 ygG 1541
Reviewer/Inspector Signature: Date: 3 / -P
12/28/04 Continued

i
Facility Number: ? — s ] Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [A No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check Cl Yes [)71 No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design g El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes fA No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbrcakers on irrigation equipment? ❑ Yes ER No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
@ No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
@ No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
28_ Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
F61 No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
© No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
if yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
R 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
® No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
n. �
...
rtional Corumemtsand/or Drawi
x
r
12/28/04

Type of Visit *Compliance Inspection O Operation Review O Lagoon Evaluation
lReason for Visit a Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Jr Date of Visit; � D Time; a' O�+►1
O Not Operational O Below Threshold
EWermitted 1316ertified p Conditionally Certified © Registered Date Last Operated or Above Threshold:
Farm Name: ... :lie ... ... A e .tts ...... --- —
Owner Name:Bl�!iT... Fi�►k!. O�J7... T!i Vi. Phone No:�.�.....------._. __.. .
Maiiing Address:.. sr� W. Ire- e-.... �Ind..
Oo
Facility Contact: N_.... .... ��xcsa,g_.. _-•------Title- Phone No:
Onsite Representative: ��Ju... �/s��G.t/(__ ._ ................._......_ ...... Integrator: -J�P / �. — .... Ftf Ptd ......... _ .._
Certified Operator,
_ .. _---- _...._.__ .............._.......... Operator Certification Number:
Location of Farm:
2<wine ❑ Poultry ❑ Cattle ❑ Horse Latitude Da 09 0" Longitude 0 ` "
Discharees & Stream Impacts
L Is any discharge observed from any part of the operation? ❑ Yes EK
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes LKo
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
El Yes R-tvo
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 EKo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes E146
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes EJKo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes QN6
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ,—Qtp..-........................
Freeboard (inches):
12112103 Continued

40
�' Facility Number: Date of Inspection -o
Required Records & Documents
21. Fail to have Certificate of Coverage &. General Permit or other Permit readily available?
❑ Yes
B'No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
14e doolje
A,
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
9 -No
23_ Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
O -No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
Su,'� he
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
R�<o
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
EWO
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
�S wed! mu�n�a,i,ppr�
(ie/ discharge, freeboard problems, over application)
❑ Yes
B -No
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
❑ Yes
U -W
28. Does facility require a follow-up visit by same agency?
❑ Yes
U -No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
93-N'o
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
2 -fes
❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
P-1"i'b
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
G 1'Qo
33. Did the facility fail to conduct an annual sludge survey?
Q -Yes
❑ No
34. Did the facility fail to calibrate waste application equipment? 2 Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below, ❑ Yes DNo
❑ 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.
s r�
ddtnonal Cotrimants'andlds Dravvtrigs
#3-3 a,,d
N / i. ?adf-M su,'d 4,e
14e doolje
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aP�/,tu{,b r eqy►pm�„ - ca l'6raTPc� 6y
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�/'e WQs
4 f Pw �/ eP5 pr T e toe- 0P
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w.►s gv,r 9 �v rem jVr,, Mr. � �,ll
+T Slw, e ocft,, G a
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re�vrt o„f% P/Gee,
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T
12/I2/03 1jl{r a!1

ti
Facility Number Z t)stc of Visit:
oZ Time: I /Z a�
rO Not Operational Below Threshold
0 Permitted ® Certified [3 Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
Farm Name: i " ir- J. � County:
Owner Name: t �v.J `�`�'`J Phone No:
Mailing Address: _ /g�d ��.�rT, �f �.Z,fia �Caad , �/!c �'� _ _ lV(f .ZF3-�
Facility Contact: Title: Phone No:
T /� r
Onsite Representative: Integrator: � ,� 15fe ..r'
Certified Operator: ,D111.411.1 Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' ' 0 K Longitude • 04 µ
Design
Current Design Current Design Ctirrenf
Swine Capacity
Population Poultry Capacity Population Cattle Ca achy POO ulaii6
❑ Wean to Feeder
❑ Layer I Dai
Feeder to Finish 7�4
1E1
,3751' ❑Non -La er ❑ Non -Dairy
❑ Farrow to Wean
- - -
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
+
❑ Boars
! Total SSLW
Number of Lagoons
10. Subsurface Drains Present ❑La oon Area ❑ S ra Field Area
Holding Ponds / Solid Traps
�3 FE] No Liquid Waste Management System
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes No
Discharge originated at: ❑ Laizoon ❑ 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 X -No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes RNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 19 No
Waste Collection & Treatment
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes KNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): `r
05/03101 Continued

Facility Number: $'2 -S-7,71 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion, ❑ Yes [R'No
seepage, etc_)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plats? ❑ 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 ,
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ,:No
Waste Applicgtion
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
KINo
11.
Is there evidence of over application? ❑l Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
91 No
12.
Crop type
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
ONO
M.
a) Does the facility lack adequate acreage for land application?
❑ Yes
UNo
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
Pio
Reguired
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
ONO
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
E No
19.
Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
N No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
10 No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
EdNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(iet discharge, freeboard problems, over application)
❑ Yes
KNo
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 [ffNo
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
sitiiarions:-(ase additi6nal;pages as`neccssary) ❑Field Copy ❑ Final Notes
C'�Oi�i�d> ��7jkiw. /•tt�Q7.a� .
/U;�ma f� s -/% ,f,' r-�'.rl. > /Ja�J' -' -r//.c o�'��j 'd�•
14; -el /.mos
Reviewer/Inspector Name 1
Reviewer/Inspector Signature:
05/03/01
Date:
Continued

Facility Number: F2, —,S7i Date of Inspection S d�
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor 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?
,W Yes ❑ No
❑ Yes A No
❑ Yes nNo
[:]Yes Z No
❑ Yes 19) No
❑ Yes �ffNo
EgYes ❑ No
Additional: Comxneatstand/br�,Drawings
05103101
05103101

State of North Carolina
Department of Environment
and Natural Resources
Michael F. Easley, Governor
William G. Ross Jr., Secretary
Gregory J. Thorpe, Ph.D., Acting Director
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
Brent & Don Jackson
Triple J Farms
1860 Christmas Tree Road
Dunn NC 28334
Dear Brent & Don Jackson:
10.9ow'A
IT 0
A&4;la L
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
November 5, 2041
� NOV� ---- - �
1' 4 2001
r ;
Subject: Notification for Wettable Acre Determination
Animal Waste Management System
Triple J Farms
Facility Number 82-577
Sampson County
A letter dated January 15, 1999 was sent to advise you about concerns associated with Certified Animal
Waste Management Plans and the method by which the irrigated acres within the plans were calculated. Only
the acres that are wetted can be credited in the waste management plan as receiving waste application. Any
acreage within the plan that can not be reached by waste application equipment can not be used as part of your
plan.y
An evaluation by Trent Allen on 7120199 was made to review the actual number of acres at your facility
that receive animal waste during land application. The evaluation of your facility has yielded one of the
following two results as indicated by the box marked with an "X".
Category 1:
The evaluation of your facility could not be completed due to a lack of information. Please
contact your Technical Specialist to assist in providing Trent Allen the necessary
information to potentially exempt your facility from undergoing a complete wettable acre
determination. Please submit this information to Trent Allen, at 225 Green Street, Suite
714, Fayetteville, NC 28301, within in 90 days of the receipt of this letter. if you have any
questions please contact Trent Allen at [phone]. If within 90 days you are unable
to provide Trent Allen with the information you are automatically required to complete
a Wettable Acre Determination as described by Category 2 below, within 180 days
of receipt of this letter.
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 Telephone [phone] Fax [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/10% post -consumer paper

Notification for Wettable Acre Determination
Animal Waste Management System
Page 2
Category 2:
❑ Your facility has been identified by the Department of Environment and Natural Resources
as a facility that may have overestimated the number of acres actually receiving animal
waste. Therefore, some or all of your fields may be exceeding the allowable loading rates
set in your Certified Animal Waste Management Plan.
In order to resolve this issue, please contact a designated Technical Specialist to have hire
or her conduct a Wettable Acre Determination for your facility. The Technical Specialist must
be one that has been approved by the Soil and Water Conservation Commission to conduct
Wettable Acre Determinations. Many Technical Specialist with the N.C. Cooperative Extension
Service, the Soil and Water Conservation Districts, the Natural Resources Conservation
Service, and the Division of Soil and Water Conservation have received this special
designation. You may also contact a private Technical Specialist who has received this
designation, or a Professional Engineer.
All needed modifications to your Animal Waste Management System must be made and
the Wettable Acres Determination Certification must be returned to DWQ within the next
180 days. if the needed modifications are not made and it the form is not returned within the
required time, DWQ will be forced to take appropriate enforcement actions to bring this facility
into compliance. These actions may include civil penalty assessments, permit revocation,
and/or injunctive relief.
Once a Wettable Acre Determination has been completed, a copy of the attached Wettable
Acre Determination Certification must be submitted to the address listed on the form. Please
note that both the owner and the Technical Specialist must sign the certification. A copy of all
the Wettable Acre Determination documentation that applies to your Waste Utilization Pian
must be kept at your facility. DWQ and the Division of Soil & Water Conservation Staff will
review all documentation during their annual visit of your facility. An additional copy must by
kept on file at the local Soil & Water Conservation District Office. Please note that if you install
or modify your irrigation system, a designated Irrigation Specialist or a Professional Engineer
must also sign the Wettable Acre Determination Certification.
Please be advised that nothing in this letter should be taken as removing from you the responsibility or
liability for failure to comply with any State Rule, State Statute, Local County Ordinance, or permitting
requirement.
If you have any questions regarding this letter, please do not hesitate to contact Sonya Avant of our
Central Office staff at (919) 733-50$3 ext. 571.
Sincerely,
wr
Greg 6,%ihorpe, Ph 6.
cc: Fayetteville Regional Office
Sampson County Soil and Water Conservation District
Facility File
Coharie Farms

Facilities Flagged/Pended for November 5, 2001
Facility
Flagged/1'ending
Number
Owner Farm Name
Address
Slatus WA PAN deficit WA Visit Date Integrutor
82-490
Ray fate
22111 Hunter Rd
F2 4864 3/5/1999 Carroll's Foods, Inc.
Clinton NC 28328
Ray fate harm
82 — 538
Randy 'Tyndall
189 Beaverdam Road
1'4 4837 1/3/1999 Carroll's Foods, Inc.
Clinton NC 28328
Randy Tyndall Farm
82-563 I.inoard Howard 1201 Howard Road 112
............. I ....... ... ........... Autryville NC 28318
Linoard Howard & Site (Old Farm)
7/20/1999 Coharle Farms
92-577 Brent & Don Jackson 1860 Christmas Tree Road 112 5434 7/20/1999 Coharic Funis
Dunn NC 28334
Triple J Farms
82-580 Ivey Peterson 1705 W. Nit E -Read Church F2 4385 W21119"
Road
Ivey Peterson Farm
Clinton NC 2I3328
82-709 Jurt Hudson
H&C Farm
4901 Old Warsaw Road F4
Turkey NC 28393
4624.2 3/22/1999 Carroll's Foods, Inc.

dW
Facilities Flagged/Pended for November 5, 2001
Facility F lagged/Pending
Number Owner/ Farm Name Address Status WA PAN deficit WA Visit Date Integrator
82-226 Reginald & Strickland 1656 Country Club Road PI 2732.4 4/27/1999 Preslage Farms
Garrett MI. Olive, NC 29365
Reginald Strickland Farm
82-282 ,lay Sullivan 4615 Giddensville Road F4 3904 6/29/1999 rDM Farms, Inc.
Faison NC 28341
S&O Swine TDMit13
82-283 Robert Allen Thornton 3210 Keener Road F4 5375.9 4/28/I999 Prestage Farms
Clinton NC 28325
Robert Allen Thornton Farm
82 —299 Bryan & !Sen King 346 South Boulevard, Suite P2 5063 6/22/1949 Carroll's Foods Inc
95
Cripple Creek Farms Clinton NC 28328
82-302 Keith Naylor 781 tioneycull Road PZ
............I ................ Clinton NC 28328
Circle N Farm
5357.16 5/5/1999 Murphy Family Forms
82-312 McLamb 382 Pig Cradle Lane F4 $167.5 4/13/1999 Murphy Family Farms
Corporation CLINTON, NC 28328
Top Ilog (Delway
23-1,232,23-3,23-4)
82-402 J&K Farms PO Box 1 112
Ilurrells NC 28444
Green Farm
4080 641711999 Brown's of Carolina, Inc.
82-423 7.ack Mccullen 1007 Lloyd tit F4 4876 4/22/1999 Preslage Farms
...... ................ Clinton NC 28328
McCullcn Farms 5&6

Facilities Flagged/Pended for November 5, 2001
Facility Flagged/Pending
Number Owner / Farm Name Address Status WA PAN deficit WA Visit Date Integrator
1'�n
82—H JCT, I.LC C/O Craig Richardson F4 4188 3/18/1')99 Murphy Family Farm-.
100 Lake Drive
....................................
QuwhiMe Nurseries 1.6 Clinton NC 211,328
82-11 Steve Peterson PO Box 108 F4 5108 6/16/1999 Brown's of Carolina, Inc.
Flarrells NC 28444
Peterson Farm
82-19
ThompKenn Farms
PO Bax 901
F4
4216
3/25/19"
Carroll's Foods, Inc.
Inc
Warsaw NC 28398
ThompKenn Farms Inc.
82-59
Robert, Thornton
352 S McCullen Rd
P2
4573
7112/1999
Cobarie Farms
Bromley
Clinton NC 28328
Thornton Enterprises (Old Farm)
82 — 154
F. Minson Sessom s;
581 Concord School Road
F4
4972.3
5/18/19"
Prestage Farms
.........................
Clinton NC 28328
Sessoms Hog Farm
82-200
Zack McCullen, Jr.
1007 Lloyd St
F+4
4195.416
4/22/1999
Prestage Farms
Clinton NC 28328
Zack McCullen Farml-4, 7-10
82-205
A. Thomas Matthis
1330 Edmond Matthis Rd.
103
5548
719/1999
C oharie Farms
........................
Clinton NC 28328
T&P Farms
82-224
Lynn 'few
200 West Arrowhead
111
3948
6/25/1999
Dogwood Farms
Clinton NC 28328
Lynn'rew Farm
Ir

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
Michael F. Easley, Governor
William G. Ross Jr., Secretary
Gregory J. Thorpe, Ph.D., Acting Director
I Tk?W'J
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT ANc7 NATURAL RESOURCES
November 1, 2001 4
MEMORANDUM
To: Regional Water Quality SupervisorNOV -6M1
i
From: Sonya Avant, Environmental Engineer Jj1,6C
Non -Discharge Compliance and Enforcement Unit
Subject: Wettable Acre Determinations for Certified and Permitted Operations
Attached is a list of the facilities in your respective regions that have been selected to receive
notification letters advising them that they have been flagged or pended for the month of
November.
Each facility will be given written notice via certified mail. The notice will include a copy of the
certification form and a deadline for response.
1 will also be sending copies of the final monthly list of selected facilities to the Division of Soil
and Water Conservation Operation Reviewers and Soil Water Conservation District Offices each
month along with an updated copy of all facilities in that county that have been either flagged or
pended. This will hopefully enable the Districts to be better able to schedule their workloads.
If you have any questions, please contact me at 733-5083 extension 571, or
[e-mail].
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 Telephone [phone] Fax [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/10% post -consumer paper

if ,
Type of Visit B Compliance Inspection O Operation Review O Lagoon Evaluation
for Visit 0 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Z Bate of Visit: f �' L-''fin►c: Printed on: 10/26/2000
Q Not Operational Q Below Threshold
1*Permitted ® Certified ©/Conditionally Certified [3 Registered Date Last Operated or Above Threshold: .........................
Farm Name: i�.r.. 4, . County:....... ... .. f'Q.''J.................... ................
,� ..... ...............................I...
Owner Name: ...... ✓,..... Qom'... / , ri.......................................... Phone No:.........A.Q,�.r.. �3 r1�,1................................
Facility Contact: ..Zc e.....aL-91ITitle: ..................... Phone No .....
4r
Mailing Address: ....f���...�,f��.� a ............ 4�€r!�f..[I ..h.......... rf............ ..........................
Onsite Representative: , `` f7/ /. L ............... --......................... Intel;rator:....%.�.C1 .e tr! ... . f .............
Certified Operator: ...... w✓.g.lc,•....fr��....... .......... .. Operator Certification Number-..,,,
.................. .............. ............................................
Location of Farm:
I�w
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �� ��� Longitude �• �� �«
Design Current
�mne
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to >rceder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current
Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑ Other
Design Current
Cattle Cavacitv Po ulation
❑ Dairy
❑ Non -Dairy
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurf ece Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps FM—No Liquid Waste ;Management System
Discharges & Stream lm acts
1. is any discharge observed from any part of the operation'? ❑ Yes 4�TNo
Discharge originated at: ElLagoon E]Spray Field E]Other
a. If discharge is observed, was the conveyance roan -made? [:]Yes ;R No
b. If discharge is observed. did it reach Winter of the State? (If yes, notify DWQ)
El Yes j$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 ERNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes JS No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? 0 Yes 19 No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes [B No
Structure I Structure 2 Structure ; Structure 4 Structure 5 Structure 6
Identi ficr: ............. . ��..... ... I ...... ......... .................
Freeboard (inches):
51Qo Continued on back
vasion ofrWater
d Division of Soil and Watelr Coniservation°
�•
" .
_
O'Qther Agency .
+
Type of Visit B Compliance Inspection O Operation Review O Lagoon Evaluation
for Visit 0 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Z Bate of Visit: f �' L-''fin►c: Printed on: 10/26/2000
Q Not Operational Q Below Threshold
1*Permitted ® Certified ©/Conditionally Certified [3 Registered Date Last Operated or Above Threshold: .........................
Farm Name: i�.r.. 4, . County:....... ... .. f'Q.''J.................... ................
,� ..... ...............................I...
Owner Name: ...... ✓,..... Qom'... / , ri.......................................... Phone No:.........A.Q,�.r.. �3 r1�,1................................
Facility Contact: ..Zc e.....aL-91ITitle: ..................... Phone No .....
4r
Mailing Address: ....f���...�,f��.� a ............ 4�€r!�f..[I ..h.......... rf............ ..........................
Onsite Representative: , `` f7/ /. L ............... --......................... Intel;rator:....%.�.C1 .e tr! ... . f .............
Certified Operator: ...... w✓.g.lc,•....fr��....... .......... .. Operator Certification Number-..,,,
.................. .............. ............................................
Location of Farm:
I�w
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �� ��� Longitude �• �� �«
Design Current
�mne
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to >rceder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current
Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑ Other
Design Current
Cattle Cavacitv Po ulation
❑ Dairy
❑ Non -Dairy
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurf ece Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps FM—No Liquid Waste ;Management System
Discharges & Stream lm acts
1. is any discharge observed from any part of the operation'? ❑ Yes 4�TNo
Discharge originated at: ElLagoon E]Spray Field E]Other
a. If discharge is observed, was the conveyance roan -made? [:]Yes ;R No
b. If discharge is observed. did it reach Winter of the State? (If yes, notify DWQ)
El Yes j$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 ERNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes JS No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? 0 Yes 19 No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes [B No
Structure I Structure 2 Structure ; Structure 4 Structure 5 Structure 6
Identi ficr: ............. . ��..... ... I ...... ......... .................
Freeboard (inches):
51Qo Continued on back

ti
Facility Number: L - Date of inspection Printed on: 10/26/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes RNo
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes q No
(lf any of questions " 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 I,No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes 23T10
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes PRNo
I i. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes allo
12. Crop type fGG�i¢ i i r-, 0z"-ji
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes NJ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes RNo
b) Does the facility need a wettable acre determination? ❑ Yes V No
C) This facility is pended for a wettable acre determination? ❑ Yes WNo
15. Does the receiving crop need improvement? ❑ Yes f9No
16. Is there a lack of adequate waste application equipment? ❑ Yes 19 No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes WNo
I& Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, heckl', desii , maps, etc.) ✓ / ❑ Yes p
19. Does record ketev/ping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes PT 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 ftNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes A 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
4 Molatidlis,oi' ftficjentk9 mere jnbted- d(Wing 4jils.vlslt: • Y:oi► ijIl •receive iici fur then; - : ,
rorrt's ouidei>ce: about: this visit_ - : - :: :
Comments {refer to- Bestion.#)E Explau any YFS ahswers and/or any recommendations 6"r any other comments -'
g
,.
Use dzewings of fatality to better -explain situations. (use additional pages as necessary)
Reviewer/inspector Name
Reviewer/Inspector Signature: Date: 6/ 5/00

i
Facility Number: Z — f!� Date of Inspection d/
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below ❑ Yes )TIO
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes KNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 0 No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located neat' the liquid surface of the lagoon? ❑ Yes Wo
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 PNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes JV No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? tYes ❑ No
bo omments an or rags
5100
5100

l . z
Reason for Visit ® Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 7 Date of Visit: /� �� Tune: la 77 Printed on: 7/21/2000
Q Not O erational Q Below Threshold
0 Permitted 0 Certified [3ConditionallyCertified E3 Registered Date Last Operated or Above Threshold: .........................
FarmNamNt .............1. K. .�,Ix:.....il. �� � ..................................................... County:.....2.................................__...........
OwnerName:.. -.4....J ............................................. Phone No:........ ... .................. ................... .2 y ...._........_..
Facility Contact: , /�c�. -d� ......rule: Phone No: ...................................................
Bailing Address:........... �r.��U
.... C ZZere ����... ...... 1�la.c�.✓ .IY...�....t`�..���.......... ..........................
Onsite Representative -..,e x?A'> G-wGl+' Uds�.. /s. 3�fJ.__. Integrator:..... _..... ............
......................... ....
Certified Operator: ........ L/i.., Operator Certification ?Number:
I/.FG�4d..........................................
............................
Location of Farm:
r1q
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ° Longitude C]• 6 «
Design Current Design Current Design Current
Swine Cavacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish f`[} ❑ Non -Layer ❑Non -Dairy
Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lngnon Area ❑ Spray wield Area
Holding Ponds I Solid Traps ❑ No Liquid %Vaste Management System
Discharges & Stream I. mpactti
1. Is any discharge observed from any part of the operation? ❑ Yes Wo
Discharge originated at: [3Lagoon [3Spray Field ❑ Other
a. If discharge is observed, was the conveyance nian-made? ❑Yes RNo
h. If discharge is observed. slid it reach Water of the State'? (If yes, notify DWQ1 ❑Yes } No
c. il'discharte is observed, what is the estimatcd 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 el No
Structurc I Structure ? Structure ; Structure 4 Structure 5 Structure G
Identificr:....................................... ............................... ........ ................................... ....... ........ ...................... ....................................
.............. .. Z
Freeboard (inches):
5100 Continued on back

Facility Number: F2— Date of Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yeso
seepage, etc.) <
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes �Vio
(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? 10Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes C No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes 'KNo
Waste Application
14. Are there any buffers that need maintenance/improvement'? ❑ Yes kNo
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes "171 No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination'?
15. Does the receiving crop need improvement'?
16. is there a lack of adequate waste application equipment?
ReQuired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all component~ of the Certified Animal Waste Management Plan readily available?
(ie/ W` , checklists, design, maps, etc.) /� ✓
19. Does record keeping need improvement! (ie/ irrigation, freeboard, waste analysis & soil satrap a reports)
cr
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 siluations as required by General Permit'?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
24. Does facility require a follow-up visit by same agency'?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes RNo
❑ Yes XNo
❑ Yes KNo
❑ Yes g[No
NgYes ❑ No
❑ Yes AfNo
❑ Yes R No
❑ Yes/j1No
❑ Yes )1_4 No
❑ Yes `No
❑ Yes jt;�No
❑ Yes No
❑ Yes No
❑ Yes KNo
❑ Yes VNo
NO yiolati$ris:oir &fici....................................................
ndes •were jn6ted- di t'itig this: visit: • Yo i� will treedve;i6 #ni#her
' r res' of de>nce. about: thi ' 'sit .. . . . . • ...... . _ ......
Comments (refer to question #): Explain any YES answers andfor any recommendations or any -other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary): _
�7��C/ r�<%� �/7�%E!J �/...��i'�� •L*�
i/K4! /G'�I'-s� 4� GjO�Q,�r'�'/��,��""T�"
w
Reviewer/Inspector Name
Reviewer/Inspector Signature: �,,, Date: �� �d S/QO

r
r _
Facility Number: -- Date of tuspection Printed on: 7121/2000
Odor Issues
25. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge 3lor helow WYes ❑ No
liquid level of lagoon or storage pond with no agitation? f
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ANo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ANO
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 'VNo
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;'Na
31. Do the animals feed storage bins fail to have appropriate cover? [:]Yes )E" No
32. Do the flush tanks lack a submerged rill pipe or a permanenthemporary cover? ❑ Yes ;9 No
5/00

HIGH FREEBOARD NOTIFICATION
DWQ Contact t4t54
Name of Person
contacting DWQ AV"e—� Yd4 fc�I
s,:a— Telephone Na.)5�0— 9s-lrii
rr
FARM Name
County
Facility No. 92—Y-77
Freeboard [eves ofthe Lagoon:
Conditions of the spray fields:
NARRATIVE: (Include any instructions given to the former of the time of the call)
I
(A copy of each notificotion should be forwarded to the 'CAFO BOX' in Jahn Hastys office
as soon as passible)

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Bill Holman, Secretary
Kerr T. Stevens, Director
Brent & Don Jackson
Triple J Farms
1860 Christmas Tree Road
Dunn NC 28334
Dear Brent & Don Jackson:
1 � •
NCDENR
NORTH CAROLINA DE=PARTMENT OF
ENVIRONMENT AND NATURAL- RESOURCES
December 30, 1999
R E C E i IV ED"
, i . 5 2000
FAYE17 E1liLLE
REG. OFFICE
Subject: Fertilizer Application Recordkeeping
Animal Waste Management System
Facility Number 82-577
Sampson County
This letter is being sent to clarify the recordkeeping requirement for Plant Available Nitrogen (PAN)
application on fields that are part of your Certified Animal Waste Management Plan.
In order to show that the agronomic loading rates for the crops being grown are not being exceeded, you
must keep records of all sources of nitrogen that are being added to these sites. This would include nitrogen
from all types of animal waste as well as municipal and industrial sludgesJresiduals, and commercial fertilizers.
Beginning January 1, 2000, all nitrogen sources applied to land receiving animal waste are required to
be kept on the appropriate recordkeeping forms (i.e. l[RRI, IRR2, DRY], DRY2, DRYS, SLUR I, SLUR2,
SLD1, and SLD2) and maintained in the facility records for review. The Division of Water Quality (DWQ)
compliance inspectors and Division of Soil and Water operation reviewers will review all recordkeeping during
routine inspections. Facilities not documenting all sources of nitrogen application will be subject to an
appropriate enforcement action.
Please be advised that nothing in this letter should be taken as removing from you the responsibility or
liability for failure to comply with any State Rule, State Statute, Local County Ordinance, or permitting
requirement.
If you have any questions regarding this letter, please do not hesitate to contact Ms. Sonya Avant of the
DWQ staff at [phone] ext. 571.
Sincerely, //
r W/
Kerr T. Stevens, Director
Division of Water Quality
cc: Fayetteville Regional Office
Sampson County Soil and Water Conservation District
Facility File
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 Telephone [phone] Fax [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/10% post -consumer paper

E ' .:
' 0 Division of Soil and Operation Review
F- .:
" 'Q Division of Soil and: -Water wConserwahon Compliance Inspection_
.. _
`~ vision of WaterQitl' i y-xComplianee Ltspection _ r
13
Other Agency. Operation Review = r
Routine Q Complaint 0 Follow-up of DWQ ins ection 0 Follow -tip of DSWC review 0 Other
Facility Number % Date of Inspection
Time of Inspection I n,'OV j 24 hr. (hh:mm)
Opermitted. [3 Certified` [3 Conditionally Certified 0 Registered 0 Not O erational Date Last Operated:
Farm N. � P !� J I a 1r .5 County: C ..... 5.� ........... .....................
. .................................................................................................... ..1
Owner Name ........ �.� 1(J _.. .......... ...... Phone No:.........s /.. ..................L.L,.....................................
2
' Phone No:
Facility Contact: ........�±7,.(,°..r............................................. Title:.................._........... ....._._ ........ ..:..... ..........
Mailing Address: ...�..LL. Q.. 4rfi/`.(..ST LY1 l�....../...L'e.....111Li................. ........��-4.4. .. `.. 25-3
..-^..... I.......................... .-...........3�..
Onsite Representative: ......_- integrator: j ............_.._.__--_-----,•-
.................. ._._......._............
Certified Operator: -.,..-5Q V1_e� ..... . .................. Operator Certification Number:
Location of Farm:
Latitude ' 6 1 Longitude a 6 °=
Discharges & Stream Impacts
i. Is any discharge observed from any part of the operation? ❑ Yes KNo
Discharge oribinated'at: ❑ Lagoon ❑ Spray Field ❑ Other
a, If discharge is observed, was the convevance than -made`'
1). If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:2� �j 2Q //
Freeboard(inches):................................................................................ - ....... ,.-11-1......
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 Etclk10
❑ YesO`No
/ ^t+r A`
❑ Yes ?�No
❑ Yes Z�No
❑ Yes A(No
❑ Yes RNo
Structure 6
❑ Yes �lo
Continued on back

Facility Number: fr2 — Date of Inspection
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenaricelimprovement?
9. Do any stuc(ures 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 ap licationj Excessive Ponding ❑ PAN
12. Crop type Cjf
13. Do the receiving crops ffer with thos designated in the Certified Animal W
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?
Management PJ6n (CAWMP)?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes 0 No
❑ Yes AfNo
❑ Yes ONo
❑ Yes ["No
❑ Yes . XNo
❑ Yes K No
❑ Yes KNo
❑ Yes JA No
❑ Yes Rj No
❑ Yes W No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes U&No
�Vo violaticjtis or defcienctes mere poled dix.. �his:v...... viii . . . . . r. i`utj-...
' corres• onde' AM' this visit .. ... .
Comments {refer to quesf<on #} Explain any YES answers aind/or aRy rec©mm_endattons orany other camments '
Usedrawmgs of facility to better eitpiatn st#uatoiis (use additsonai°pages as necessary) �`
Farm I's I'& aa S11410e, p,� I ef
�i W" IA
�ern�l��ao/
oo 61 o ✓e a.%_
..5
Reviewer/Inspector Name =.- "lT
Reviewer/Inspector Signature: Date:
V U 3123199

!# ,
Facility Number: 7 Date of inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below jNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? [:]Yes U<No
28. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 4KNo
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 /C�rNo
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 ;XNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 4dNo
32. Do the flush tanks lack a submerged fill pipe or a perm anon themporary cover? s RN
- tiona ...omments and/or -awtn
3123/99
3123/99

0 Division of Soil and Water Conservation ❑ Other Agency
WDivision of Water Quality
IS Routine O Complaint O follow-up of DWQ inspection O Follow-up of DSWC review O Other J
Date of luspection /6
Facility Number .Z Time of Inspection 2 =� 24 hr. (hh:mm)
0 Registered 0 Certified ®j Applied for Permit O Permitted E]Not O erational Date Last Operated:..,.. _,,, ...
FarmName: ............... !' ....... ............................................ County:....... ..1 .........................................
Owner Name: ......... ..i ....... /d `' ................................. Phone No: ..1.�.......t. sr/...............,..
Facility Contact:.......... 134,`....�....Sf�J'!.'`�....... Title:..................................n............................. Phone No:p....................
.......... ....................
Mailing Address: 1 ��� 4-�� 5..�.T%��� ....�t?s........ .... Lt....... ....... G......_2d-33y. ..... ...... ....._........
Onsite Representative: .............................................................................. Integrator:...C:�rt!...C"�tf'�gr.....
Certified Operator ,....... �??!f r+l..... ....... � ...................... Operator Certification Number;...,,�../--`��...........
Location of Farm:
r'....-1�Q7... ........_.._ ...-...................... ............................. ...._... _......._....
Latitude �•�1 41 Longitude 0• ° 94
"a^ zc --^
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Current
aT1
Subsurface Drains Present 110 Lagoon Area J❑ Spray Field Area
h „❑ No Liquid Waste Management System
General
`J'
❑ Layer
`
❑ Dairy
7
2. Is any discharge observed from any part of the operation?
❑ Nan -Layer
birNo
❑ Nan -Dai
Z x
>` ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
Total, Design Capact3
b. If discharge is observed, dict it reach Surface Water? (If yes. notify DWQ)
❑ Yes
kNo
br .r i R �• Gal MR Y
Total-SSLW
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
aT1
Subsurface Drains Present 110 Lagoon Area J❑ Spray Field Area
h „❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
A No
2. Is any discharge observed from any part of the operation?
❑ Yes
birNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
XNo
b. If discharge is observed, dict it reach Surface Water? (If yes. notify DWQ)
❑ Yes
kNo
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
[] Yes
VNo
3. is there evidence of past discharge from any part of the operation?
❑ Yes
kNo
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
JRNo
5. Does any part of the waste management system (other than lagoonstholding ponds) require
❑ Yes
RNo
mai ntenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
CR No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
XNo
7125/97

22. Does record keeping need improvement? ❑ Yes gNo
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes P15to
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes P(No
25. Were any additional problems noted which cause noncompliance of the Permit? ❑ Yes 9No
v
No vialations�or. deficieneie's.were-noted,during this,visifYou:will recei've Ro•furtliei~
correspOfide0e. about this:visat:
"U..' Y k �Su➢,"Yb o�n�_., .:. ...� ,� _... b .. �. qFr- ✓pa+. r, s3•yw - ?'S',w.x
en
ersan
ttlatiOtlS. ttseadtltt,anal y�recn � t�ottsarany other cOmrgents
1rawr�nf.faht be #ttei,�IAn3Stge
7/25197
Facility Number:KZ—_;0.7;7J
T
8.
Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
)KNo
Structures fLnoons.Holdinp.Ponds Flush Pits etc
9_
is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes'XNo
Structure l Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Freeboard(ft):......... 3..............•...............,.................................................. .............................
........... ...................................................
10.
Is seepage observed from any of the structures'?
❑ Yes
)<No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
I No
12.
Do any of the structures need maintenancetimprovement?
Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
)No
Waste A licatio
14.
Is there physical evidence of over application?
❑ Yes
JqNo
(If in excess of WAV, or runoff entering waters of the State, notify DWQ)
15.
Crop type :... .r� r..11lrl� .G��.[.e�✓ e��...................................
y. r
16.
Do the receiving crops differ with those designated in the Animal Waste Management Pian (AWMP)?
❑ Yes
J No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
® No
18.
Does the receiving crop need improvement?
❑ Yes
KNo
19.
Is there a lack of available waste application equipment?
❑ Yes
A No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
54 No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
❑ Yes
D9 No
22. Does record keeping need improvement? ❑ Yes gNo
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes P15to
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes P(No
25. Were any additional problems noted which cause noncompliance of the Permit? ❑ Yes 9No
v
No vialations�or. deficieneie's.were-noted,during this,visifYou:will recei've Ro•furtliei~
correspOfide0e. about this:visat:
"U..' Y k �Su➢,"Yb o�n�_., .:. ...� ,� _... b .. �. qFr- ✓pa+. r, s3•yw - ?'S',w.x
en
ersan
ttlatiOtlS. ttseadtltt,anal y�recn � t�ottsarany other cOmrgents
1rawr�nf.faht be #ttei,�IAn3Stge
7/25197
T
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: 10 .?z

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Wayne McDevitt, Secretary
A. Preston Howard, Jr., P.E., Director
July 24, 1998
Don Jackson _
Triple J Farms �G �'
1860 Christmas Tree Rd RECEI !f�
Dunn NC 28334
IJWW
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT ANP NATURAL RESOURCES
JUL 2 71998 Subject: Application No. 82-0577
Additional Information Request
FAYEiTEVILLE Triple J Farms
REG. OFFICE Animal Waste Operation
Sampson County
Dear Don Jackson:
The Non -Discharge Permitting Unit has completed a preliminary engineering review of the subject
application. Additional information is required before we can continue our review. Please address and submit
the following information by August 23, 1998:
] . Operation and Maintenance Plan for your lagoons is missing.
Please reference the subject permit application number when providing the requested information. All
information should be signed, sealed, and submitted in duplicate to my attention at the address below. The
information requested by this letter must be submitted on or before August 23, 1998 or the Division will return
your application as incomplete in accordance with 15A N.C.A.C. 2H.0200 and your facility will be considered to
be operating without a permit.
Please be advised that operation of the subject animal waste management system without a valid permit is
a violation of North Carolina General Statute 143-215.1 and will subject you to the enforcement authority of the
Environmental Management Commission.
If you have any questions regarding this request, please call me at [phone], extension 363.
Sincerely,
JR Joshi
Soil Scientist
Non -Discharge Permitting Unit
cc: Fayetteville Regional Office, Water Quality
Permit File
P.O. Box 29535, Raleigh, North Carolina 27626-0535 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recyded/10% post -consumer paper

Date of Inspection U4 '?
Facility Number ea- S�j�� Time of Inspection I 17- 24 hr. (hh:mm)
egister �ed © Applied for Permit 13 Permitted JE3 Not Operational Date bast Operated:...,,,,,,....
-------------
FarmName: ..........`i -i

Facility Number: .. —..5�
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 10 No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes .IN No
8. Are there L-4po tfs or stwW on on site which need to be properly closed? ® Yes ❑ No
$tructures [Lagoons and/oE Holding P2a1
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes [}No
Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
10.
Is seepage observed from any of the structures?
❑ Yes
ftNo
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
RNo
12.
Do any of the structures need maintenance/improvement?
1E Yes
❑ No
�
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
10 Yes
[] No
%Vaste Application
14.
Is there physical evidence of over application?
❑ Yes
29 No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type �... ..... C t"a raa-e, �...�......_.......r....._...............
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?,
❑ Yes
® No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
Jjj No
18.
Does the receiving crop need improvement?
❑ Yes
19 No
19.
Is there a lack of available waste application equipment?
❑ Yes
Pio
20.
Does facility require a follow-up visit by same agency?
RYes
❑ No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
❑ Yes
® No
For
Certified Facilities Only
22.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
❑ No
23.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
24.
Does record keeping need improvement?
❑ Yes
❑ No
_ .`°�`
Comments refer to' �esho�iora'
(, qu w#f} Explainany YES answeis and/or any recommendations or any other comments:
Use iliawtngs of facility to'better explain situations .(use,addttionat pages as necessary)
a<<:M,
F
i= a
j „ s ..,�„.g ri d( M^t r CQti iar� �i t �a►�l S �ti 'S Ne Ora GPSS o C R_AA%-* V' A&
Reviewer/Inspector Signature: 4'-1.9
cp—
_ Date:
5 1
.r i o'v';�-t LJl'4� �lCC_s els Ca,7� ij'1_�CO %` .
3
�
Reviewer/Inspector Named
a<<:M,
F
i= a
a s
Reviewer/Inspector Signature: 4'-1.9
Qruj-'_ �
_ Date:
5 1
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

Facility Number: 1
Division of Environmental Management
Animal Feedlot Operations Site Visitation Record
Date:a-7 A
Time: lI ; 3 {{6
General Information:
Farm Name: 1= •T�S �� County: s I' I -"-
Owner Name: S \ j,_ -- , S P- � L� S �,,, _^Phone No: r -1 3 `f
On Site Representative: r �� S c,� -- Integrator. Co �k at -t -Cl—
Mailing Address:__ P_Q L- 6 G e -- -
Physical
Oppration Description: (based on design characterioics)
e.j
n7
Type of Swine No. of AnimaLs Type of Poultry No. of AnimaLs Type of Cattle No. of Animals
0 Sow 0 Layer 0 Dairy
0 Nursery 0 Non -Layer 0 Beef
0 Feeder
ChherType of Livestock: S k,.^ Number of Animals: 3 q o 0
Number of Lagoons: 3 (include in the Drawings and Observations the fireeboard of each lagoon)
Facility Inspection
Lagoon
Is lagoon(s) fireboard less than 1foot + 25 year 24 hour storm storage?:
Yes O
No e
Is seepage observed from the lagoon?:
Yes 0
No)Z
Is erosion observed?:
Yeses:
No 0
Is any discharge observed?
Yes 0
Nam
0 Man-made 0 Not Man-made
Cover Crop
Does the facility need more acreage for spraying?:
Yes 0
Nom
Does the cover crop need improvement?:
Yes U
Nom"
( list the crops which rued impr crement
Crop type: i.Acreage:
Setback Criteria -
Is a dwelling located within 200 feet of waste application?
Yes O
Nq�r
Is a well located within 100 feet of waste application?
Yes 0
NqO
Is animal waste stockpiled within 100 feet of USGS Blue Line Stream?
Yes 0
NoZr
Is animal waste land applied or spray irrigated within 25 feet of Blue Line Stream? Yes 0 Nqer
AOI -- January 17,19%
a

Maintenance
Does the facility maintenance need improvement? Yeses' No 0
Is there evidence of past discharge from any part of the operation? Yes 0 No P`'
Does record keeping need improvement? Yes 0 NoW
Did the facility fail to have a copy of the Animal Waste Management Plan on site? Yes 0 Nga
Explain any Yes answers:_ _N�s_
.-- �0-VZ <_,�, I L..
Signau=: Date: %�lo
cc. Facility Assessment Unit Use Attachnunts if Needed
Drawinas Or Observations -
5 ftoo r 5
`3 �20�,
AOI - January 17,19%

State of North Carolina
Department of Environment,
Health and Natural Resources
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
November 13, 1996
James Wright Jackson
Triple J Farms
Rt 5 Box 668
Dunn NC 28334
SUBJECT: Operator In Charge Designation
Facility. Triple J Farms
Facility ID#: 82-577
Sampson County
Dear Mr. Jackson:
V F_= H N FR
M"ECEIVED
NOV 19 1996
FAYETTEVl? LE
AFC. OFFi♦CE
Senate Bill 1217, An Act to Implement Recommendations of the Blue Ribbon Study
Commission on Agricultural Waste, enacted by the 1996 North Carolina General Assembly,
requires a certified operator for each animal waste management system that serves 250 or more
swine by January 1, 1997. The owner of each animal waste management system must submit a
designation form to the Technical Assistance and Certification Group which designates an
Operator in Charge and is countersigned by the certified operator. The enclosed form must be
submitted by January 1, 1997 for all facilities in operation as of that date. Failure to designate a
certified operator for your animal waste management system is a violation of 15A NCAC 211
.0224 and may result in the assessment of a civil penalty.
If you have questions concerning operator training or examinations for certification, please
contact your local North Carolina Cooperative Extension Service agent or our office.
Examinations have been offered on an on-going basis in many counties throughout the state for
the past several months and will continue to be offered through December 31, 1996.
Thank you for your cooperation. If you have any questions concerning this requirement please
call Beth Buffington or Barry Huneycutt of our staff at 919!733-0026.
Sincerely,
A. Preston Howard, Jr., P.E., Director
Division of Water Quality
Enclosure
cc: Fayetteville Regional Office
Water Quality Files
P.C. Box 27687, �y�
Raleigh, North Carolina 27611-7687 a An Equal opportunity/Affirmative Action Employer
Voice 919-715-4100 50% recycled/ 10% post -consumer paper

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Wayne McDevitt, Secretary
A. Preston Howard, Jr., P.E., Director
May 29, 1998
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
Brent & Don Jackson
Triple J Farms
1964 Christmas Tree Rd
Dunn NC 28334
Farm Number: 82 - 577
Dear Brent & Don Jackson:
MU."WAA
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVMONMENT AND NATURAL REsouRCEs
RECEIVED
AN 0 4 1998
FAYETTEI.sILLE
REG. OFFICE
You are hereby notified that Triple J Farms, in accordance with G.S. 143-215.1 OC, must apply
for coverage under an Animal Waste Operation General Permit. Upon receipt of this letter, your farm
has six 60 days to submit the attached application and all supporting documentation. In accordance
with Chapter 626 of 1995 Session Laws (Regular Session 1996), Section 19(c)(2), any owner or
operator who fails to subunit an application by the date specified by the Department SHALL NOT
OPERATE the animal waste system after the specified date. Your application must be returned
within sixty (60) days of receipt of this letter. Failure to submit the application as required may also
subject your facility to a civil penalty and other enforcement actions for each day the facility is operated
following the due date of the application.
The attached application has been partially completed using information listed in your Animal
Waste Management Plan Certification Form. If any of the general or operation information listed is
incorrect please make corrections as noted on the application before returning the application package.
The signed original application, one copy of the signed application, two copies of a general location
map, and two copies of the Certified Animal Waste Management Plan must be returned to complete the
application package. The completed package should be sent to the following address:
North Carolina Division of Water Quality
Water Quality Section
Non -Discharge Permitting Unit
Post Office Box 29535
Raleigh, NC 27626-0535
If you have any questions concerning this letter, please call Sue Homewood at [phone]
extension 502 or Jeffery Brown with the Fayetteville Regional Office at [phone].
Sincerely,
A. Pres on Howard, Jr., P.E.
cc: Permit File (w/o encl.)
Fayetteville Regional Office (w/o encl.)
P_O. Box 29535, Raleigh, North Carolina 27626-0535 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

Farm Name/Owner:
Site Requires Immediate Attention: /16jo
Facility No. s
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995
Time: 3 f io
Mailing Address:_ —G/ -A
County:
Integrator: Phone:
On Site Representative:.' Phone:
Physical AddreWLocation:
f
Type of Operation: Swine Poultry Cattle
Design Capacity: <e.O a � _ Number of Animals on Site: -32-JM
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: «
Does the Animal Waste
(approximately I Foot +
Was any seepage observed
Is adequate land available
Crop(s) being utilized:
Does the facility meet SCS
Circle Yes or No
Lagoon h e sufficient freeboard of 1 Foot + 25 year 24
7 inches) �'e�}ar No Actual Freeboard: 'Z -Ft -
from
Ft_
from the 12 oon(s)? Yes or No Was any erosion observed?
for spray? Ye or No Is the cover crop adequate? &1or Ni
hour storm event
_Inches
Yes or
minimum setback criteria? 200 Feet from Dwellin s? V&3)or No
100 Feet from Wells? or No
Is the animal waste stockpiled within I00 Feet of USGS Blue Line Stream? Yes or &o
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or 63
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or 1� If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)?egar No
Additional Comments:
Inspector Nailit
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: " A ZD , 1995
Time:
%V 25
Farm Name/Owner:
Mailing Address:
County:
Integrator: Phone:
On Site Representative: Phone:
Physical Address/Location:
Type of Operation: Swine Poultry Cattle
Design Capacity: Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: ° Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes or No Actual Freeboard: Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes or No
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map BIue Line: Yes or No
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, Iand applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments:
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

WTER aR-ITY P. *Vl,'Na_ pout:91(}-?15-503? Ju] ] '95 13:-5
'
*
P. 01;01I
O
�tt^Qrand tr�rninal
�n1r�tQ w
It the anima3. co. ►�",'
..open
designed to °io` •••
f cattle, 73
horses,.:250 y, • __,.s
tn-at are served by
�a ligi:ic!' Wastt __.�� norm must. be filled
-out. and mailed
'di
by Decerabe_ 31, - ��:o pursuant;.to'15A .NCAC 2H. 021-71(c) in' 6 . to be '
deemed- permitted by DEM.. Please, print cleirly'
Farm flame:T*r.a s
Mailinq Adcire s . -
-ZEE
TV 73
County: . FI:�ne Vo. B'9�- �-
Owner (a)Name: �s+�t;.s DRi—
Managdr (s) Name:
Lessee Name:
..Farm Lccatio.-� iBe as spec_fi as pos i =e:; toed
napes. dixtctior.
tniiep t`; etc .l -
�.
_
� G.:F.�1�-+�rh�p".mak- �:::-:__: ..�.. --- • .., . .. . _
.
Designcapacity ;of rUm i is 3te +snag ziertit f-systam (Number: and type
of, ,confined anit' (s.)
Average:arima'. goelation-on. he far.r,.Mimb r_d
type of animal(s)
rL
Year lP:oduction Began -'1 �;� AgcS_. 'raci' No.
-17Q
•._ .rr�L � Jnr
Type of -Taste- Mistageayesrt = S.ystent :(3se.d •�
L
i " AJ r ,
- T—
ACrts.;.AvaSxah.la'_�ror:x:ai_rd AppZieation o�`wa�•stsr
:.g�.A�ea
Owner (s) Sig!iature13,
DAJEi
elf- It
Go.- -i-v.. 1. "r f�d�at - � o � .- ,�� 7� r... -'V, .� B
a�P10 1)1- 3� P
�►.I�s o� le ie;(-,

umv Psat ADVIlt-fill"a ASIOICIAII IM 0,

Plan Amendment iu tncivae Z)6awc.t. k-iili)ill4. t%.aiivaia rractices auu
2000
1. If this facility can comply with its existing permit and CAWMP it must do so.
2. Temporary Addition of New Spraylields (*) (Check appropriate boxes.)
[] A. acres of cropland. List crop types used:
[] B. acres of hardwood woodland @ 100 lbs PAN / acre added.
__ []
C. acres of pixie woodland added @ 60 lbs PAN / acre added.
3. Summer Perennial Grass (Check appropriate box.)
[] A. Application window extended for acres of perennial grass until first killing frost.
[] B. An additional 30 lbs of PAN applied to acres of perennial grass prior to killing frost_
4. PAN Application Increased for Small Grains & Winter Grasses to be harvested. (Check appropriate
box.)
0 A PAN application increased up to 200 lbs per acre for 7� acres of small grains or winter
Qrassesto be harvested.
[] B. PAN application increased up to 150 lbs per acre for acres of overseeded summer
perennial included in 3. B.
3. Waste Analysis (Check appropriate box.)
Prior to December 1st, 1999 the calculation of PAN will be based on a 35°'o reduction of the last
analysis taken
prior to the first 25 year 24 hour storm event. (Current waste analysis trust be used after Dec. ist .)
[] B. Use current waste analysis to determine PAN_
6. Required - Maximum Nitrogen titilization Measures for Small Grains and Winter Grasses.
A. Use of higher seeding rates,
B_ Timely harvest of forage to increaseyield, and
C. Irrigating during periods of warmer weather_
7. Required - Irrigation Management Techniqueto R:duce Runoff and Ponding Potential.
A. Making frequent; light irrigation applications', and
B. Not imszatina immediately before predicted rainfall.
S. The owner / manager is required to manage the movement of animals to and from the facility to
minimize environmental impacts, ensure compliance with the facility's permit and amended CAWMP,
and avoid discharge to surface waters.
9. Authorization to use the additional oraciices included in this amendment exDires if a faciiiry
dischanzes to suFmce waters. Any discharge is a violation and may result in an enforcement action_
10_ The owner / operator is required to keep records of all waste applications.
1 l _ This revision must include a man or sketch of new land application areas.
Faciiity Number 9' -L - �5 Yi
Faciliry Name f p r p -LC.- NA�rn S
Facilitv fawner / Manager Name (PRLN'T) Technicai Spe- alist N e (P i )
Faciiiry Own, Manager Signature Technical Specialist mature
Date Date /�-