820136_INSPECTIONS_20171231

NORTH CAROLINA
P
Department of Environmental Qua

M Division of Water Resources
❑ Division of Soil and Water Conservation
❑ Other Agency
Facility Number:
820136
Facility Status: Active
Permit AWS820136
[] Denied Access
Inpsection Type:
Compliance Inspection
Inactive Or Closed Date:
Reason for visit
Routine
County:
Sampson Region:
Fayetteville
Date of Visit:
03/22/2017 Entry Time: 12:00 pm Exit Time: 12:30 pm Incident s
Fans Name:
Ingold Sow Farm
Owner Ernail:
Owner.
Murphy -Brown LLC
Phone:
910-296-1800
Mailing Address:
PO Box 487
Warsaw NC 28398
Physical Address:
672 Lisbon Bridge Rd
Garland NC 28441
Facility Status:
Compliant ❑
Not Compliant Integrator
Murphy -Brown LLC
Location of Farm:
latitude:
34° 48' 33" Longitude:
78° 20' 44"
On the west side of SR
1134 approx..6 miles south of its intersection with Hwy 701 at Ingold, NC.
Question Areas:
Dischrge & Stream Impacts
Waste Col, Stor, & Treat
Waste Application
Records and Documents
Other Issues
Certified Operator. Eddie L Jones Operator Certification Number: 16291
Secondary OIC(s):
On -She Representative(s). Name Title Phone
24 hour contact name Mike Ammons Phone :
On -site representative Mike Ammons Phone:
Primary Inspector: Robert Marble Phone:
inspector Signature: _ Date:
Secondary Inspector(s):
Inspection Summary:
page: 1

f +
Permit: AWS820136 Owner - Facility: Murphy -Brown LLC Facility Number. 820136
Inspection Date: 03/22/17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations Design Capacity Current promotions
Swine
Swine - Farrow to Wean 4,102
Total Design Capacity: 4,102
Total SSLW: 1,776,166
Waste Structures
Diaignated Observed
Type Identifier Closed Date start Data Freeboard Freeboard
Lagoon 1 32.00
page: 2

Permit: AWS820136 Owner - Facility : Murphy -Brown LLC Facility Number: 820136
Inspection Date: 03/22/17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Dis ha es & Stream Impacts
Yes
No Na No
1. Is any discharge observed from any part of the operation?
❑
M ❑
❑
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
❑ m
❑
b. Did discharge reach Waters of the State? (if yes, notify DWQ)
❑
❑ M
❑
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)
❑
❑ M
❑
2. Is there evidence of a past discharge from any part of the operation?
❑
0 ❑
❑
3. Were there any observable adverse impacts or potential adverse impacts to Waters of the
❑
0 ❑
❑
State other than from a discharge?
Waste Collection. Storage & Treatment
Yes
No Na so
4. Is storage capacity less than adequate?
❑
0 ❑
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (I.e./ large
❑
❑
❑
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a
❑
0 ❑
❑
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
❑
0 ❑
❑
8. Do any of the structures lack adequate markers as required by the permit? (Not applicable
❑
M ❑
❑
to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑
M ❑
❑
maintenance or improvement?
Waste Application
You No Na No
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ ■ ❑ ❑
maintenance or improvement?
11. Is there evidence of incorrect application?
❑ 0 ❑ ❑
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
❑
PAN?
❑
Is PAN > 10%/10 lbs.?
❑
Total Phosphorus?
❑
Failure to incorporate manure/sludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
page: 3

Permit: AWS820136 Owner - Facility : Murphy -Brown LLC Facility Number. 820136
Inspection Date: 03/22/17 Inppection Type: Complianoe Inspection Reason for Visit: Routine
Waste Application
Yes No Na Nee
Crop Type 1
Coastal Bermuda Grass
(Hay, Pasture)
Crop Type 2
Small Grain Overseed
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Autryville loamy sand, 0 to
6% slopes
Soil Type 2
Johns fine sandy loam
Soil Type 3
vvagram loamy sand, o to
6% slopes
Soil Type 4
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste
❑
0 ❑
❑
Management Plan(CAWMP)?
15. Does the receiving crop and/or land application site need improvement?
❑
❑
❑
1S. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
❑
0 ❑
❑
determination?
17. Does the facility lack adequate acreage for land application?
❑
0 ❑
❑
18. Is there a lack of properly operating waste application equipment?
❑
E ❑
❑
Records and Documents
Yes
No Na Ne
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑
0 ❑ ❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑M
❑ ❑
If yes, check the appropriate box below.
WUP?
❑
ChecIdists?
❑
Design?
❑
Maps?
❑
Lease Agreements?
❑
Other?
❑
If Other, please specify
21, Does record keeping need improvement?
❑
■ ❑ ❑
If yes, check the appropriate box below.
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
❑
Weather code?
❑
page: 4

Permit: AWS820136 Owner - Facility : Murphy -Brown LLC Facility Number. 820136
Inspection Date: 03/22/17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents
Yes No Na No
Rainfall?
❑
Stocking?
❑
Crop yields?
❑
120 Minute inspections?
❑
Monthly and 1" Rainfall Inspections
❑
Sludge Survey
❑
22_ Did the facility fail to install and maintain a rain gauge?
❑
E ❑
❑
23. If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment
❑
E ❑
❑
(NPDES only)?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
01311
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check the
❑
0 ❑
❑
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?
❑
■ ❑
❑
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
E ❑
❑
Otherissues;
Yes No Na No
28. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑
0 ❑
❑
and report mortality rates that exceed normal rates?
29. At the time of the inspection did the facility pose an odor or air quality concern? If yes,
❑
0 ❑
❑
contact a regional Air Quality representative immediately.
30. Did the facility fail to notify regional DWQ of emergency situations as required by Permit?
❑
N ❑
❑
(i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility?
❑
❑
❑
If yes, check the appropriate box below.
Application Field
❑
Lagoon / Storage Pond
❑
Other
❑
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or
❑
❑
❑
CAWMP?
33. Did the Reviewer/Inspector fail to discuss reviewrnspection with on -site representative?
❑
0 ❑
❑
34. Does the facility require a follow-up visit by same agency?
❑
0 ❑
❑
page: 5

0 Division of Water Resources
❑ Division of Soil and Water Conservation
❑ Other Agency
Facility Number.
820136 Facility Status: Active
permit: AWS820136
❑ Denied Access
Inppection Type:
Compliance Inspection
Inactive Or Closed Date:
Reason for Visit:
Routine County:
Sampson Region:
Fayetteville
Date of Visit:
07/29/2015 Entry Time: 12:00 pm Exit Time: 1:00 pm Incident 0
Farm Name:
Ingold Sow Farm
Owner Email:
Owner:
Murphy -Brown LLC
Phone:
91D-296-1800
Mailing Address:
PO Box 487
Warsaw NC 28398
Physical Address:
672 Lisbon Bridge Rd
Garland NC 28441
Facility Status:
NCompliant ❑ Not Compliant Integrator.
Murphy -Brown LLC
Location of Farm:
Latitude:
34° 48' 33" Longitude:
78' 29 44"
On the west side of SR
1134 approx..6 miles south of its intersection with Hwy 701 at Ingold, NC.
Question Areas:
Dischrge 8 Stream impacts Waste Col, Stor, 8 Treat
Waste Application
Records and Documents
Other Issues
Certified Operator: Wayne O Sanderson Operator Certification Number: 17903
Secondary OIC(s):
On -Site Representative(s): Name Title Phone
24 hour contact name Mike Ammons Phone :
On -site representative Mike Ammons Phone:
Primary Inspector:
Inspector Signature:
Secondary Inspector(s):
Inspection Summary:
Robert Marble Phone:
Date:
page: 1

I
Permit: AWS820136 Owner - Facility : Murphy -Brown LLC Facility Number: 820136
Inspection Date: 07/29/15 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations Design Capacity Current promotions
Swine
❑ Swine - Farrow to Wean
3,765
Swine -Feeder to Finish
976
E] Swine - Wean to Feeder
480
Total Design Capacity: 5,221
Total SSLW: 1,776,405
Waste Structures
Disignated Observed
Type Identifier Closed Date Start Date Freeboard Freeboard
Lagoon 1 49_00
page: 2

1
Permit: AWS820136 Owner - Facility : Murphy -Brown LLC Facility Number: 8.20136
Inspection Date: 07/29/15 Inppection Type: Compliance Inspection Reason for Visit: Routine
Discharges & Stream Impacts
Yea No Na Ne
1. Is any discharge observed from any part of the operation?
❑
❑
❑
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
❑ ■
❑
b. Did discharge reach Waters of the State? (if yes, notify DWQ)
❑
❑ s
❑
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)
❑
❑ M
❑
2. Is there evidence of a past discharge from any part of the operation?
❑
M ❑
❑
3. Were there any observable adverse impacts or potential adverse impacts to Waters of the
❑
0 ❑
❑
State other than from a discharge?
Waste Collection, Storage & Treatment
Yes No Na Ne
4. Is storage capacity less than adequate?
❑
M ❑
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (Le] large
❑
M ❑
❑
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a
❑
0 ❑
❑
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
❑
M ❑
❑
8. Do any of the structures lack adequate markers as required by the permit? (Not applicable
❑
❑
❑
to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑
M ❑
❑
maintenance or improvement?
Waste Application
Yes No Na Ne
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ 0 ❑ ❑
maintenance or improvement?
11. Is there evidence of incorrect application?
❑ 0 ❑ ❑
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
❑
PAN?
❑
Is PAN > 10%/10 lbs.?
❑
Total Phosphorus?
❑
Failure to incorporate manure/sludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
page: 3

Permit: AWS820136 Owner - Facility : Murphy -Brown LLC Facility Number: 820136
Inspection Date: 07/29/15 lnpsection Type: Compliance Inspection Reason for Visit: Routine
Waste Application
Yes No Na No
Crop Type 1
Coastal Bermuda
Grass
(Hay, Pasture)
Crop Type 2
Small Grain Overseed
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Autryville
Soil Type 2
Johns
Soil Type 3
Wagram
Soil Type 4
Soil Type 5
Soil Type 6
14, Do the receiving crops differ from those designated in the Certified Animal Waste
❑
0 ❑
❑
Management Plan(CAWMP)?
15. Does the receiving crop and/or land application site need improvement?
❑
0 ❑
❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
❑
M ❑
❑
determination?
17. Does the facility lack adequate acreage for land application?
❑
0 ❑
❑
18. Is there a lack of properly operating waste application equipment?
❑
M ❑
❑
Records and Documents
vgs No Na Ne
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑ ■ ❑ ❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑ M ❑ ❑
If yes, check the appropriate box below.
WU P?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Lease Agreements?
❑
Other?
❑
If Other, please specify
21. Does record keeping need improvement?
❑ ❑ ❑
If yes, check the appropriate box below.
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
❑
Weather code?
❑
Rainfall?
❑
Stocking?
❑
page: 4

e k
Permit: AWS820136 Owner - Facility : Murphy -Brown LLC Facility Number: 820136
Inspection Date: 07/29/15 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents
Yes
No Na Ne
Crop yields?
❑
120 Minute inspections?
❑
Monthly and 1" Rainfall Inspections
❑
Sludge Survey
❑
22. Did the facility fail to install and maintain a rain gauge?
❑
E ❑
❑
23. If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment
❑
❑
❑
(NPDES only)?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
0 ❑
❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check the
❑
❑
❑
appropriate box(es) below:
Failure to complete annual sludge survey
❑
Failure to develop a POA for sludge levels
❑
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?
❑
N ❑
❑
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
0 ❑
❑
Otherlssues
Yes
No Na Ne
28. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑
0 ❑
❑
and report mortality rates that exceed normal rates?
29. At the time of the inspection did the facility pose an odor or air quality concern? If yes,
❑
■ ❑
❑
contact a regional Air Quality representative immediately.
30. Did the facility fail to notify regional DWQ of emergency situations as required by Permit?
❑
0 ❑
❑
(i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility?
❑
0 ❑
❑
If yes, check the appropriate box below.
Application Field
❑
Lagoon I Storage Pond
❑
Other
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or
❑
E ❑
❑
CAWM P?
33. Did the Reviewertinspector fail to discuss review/inspection with on -site representative?
❑
■ ❑
❑
34. Does the facility require a follow-up visit by same agency?
❑
E ❑
❑
page: 5

4
0 Division of Water Resources
Division of Soil and Water Conservation
❑ Other Agency
Facility Number:
820136
Facility Status: Active Permit: AVVS820136
❑ Denied Access
Inppection Type:
Compliance Inspection
Inactive Or Closed Date:
Reason for visit:
Routine
County: Sampson Region:
Fayetteville
Date of Visit:
10/23/2014 Entry Time: 10:00 am Exit Time: 11:00 am Incident #
Farm Name:
Ingold Sow Farm
Owner Email:
Owner:
Murphy -Brown LLC
Phone:
910-296-1800
Mailing Address:
PO Box 487
Warsaw NC 28398
Physical Address:
672 Lisbon Bridge Rd
Garland NC 28441
Facility Status:
Compliant ❑
Not Compliant Integrator. Murphy -Brown LLC
Location of Farm-
Latitude: 34' 48' 33" Longitude:
78' 20' 44"
On the west side of SR
1134 approx..6 miles south of its intersection with Hwy 701 at Ingold, NC.
Question Areas-
Dischrge & Stream Impacts
Waste Col, Stor, & Treat Waste Application
Records and Documents
Other Issues
Certified Operator: Wayne O Sanderson Operator Certification Number: 17903
Secondary OIC(s):
On -Site Representative(s): Name Title Phone
24 hour contact name Mike Ammons Phone
On -site representative Mike Ammons Phone
Primary Inspector: Robert Marble Phone:
Inspector Signature: Date:
Secondary Inspector(s):
inspection Summary:
page: 1

0. ti
Permit: AWS820136 Owner - Facility : Murphy -Brown LLC Facility Number: 620136
Inspection Date: 10/23/14 Inssection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations
Swine
Design Capacity Current promotions
Swine - Farrow to Wean
3,765
Swine - Feeder to Finish
976
❑ Swine - Wean to Feeder
480
Total Design Capacity: 5.221
Total SSLW: 1,776,405
Waste Structures
Disignated Observed
Type Identifier Closed Date Start Date Freeboard Freeboard
Lagoon 1 39.00
page: 2

Permit: AWS820136 Owner -Facility: Murphy -Brown LLC Facility Number: 820136
Inspection Date: 10/23/14 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Discharges & Stream Impacts
Yes
No Na No
1. Is any discharge observed from any part of the operation?
❑
❑
❑
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
❑
❑
b. Did discharge reach Waters of the State? (if yes, notify DWO)
❑
❑ M
❑
c. What is the estimated volume that reached waters of the Slate (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?
❑
011
❑
3. Were there any observable adverse impacts or potential adverse impacts to Waters of the
❑
■ ❑
❑
State other than from a discharge?
Waste Collection, Storage & Treatment
Yes No No Ne
4. Is storage capacity less than adequate?
❑
0 ❑
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (I.e./ large
❑
0 ❑
❑
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a
❑
■ ❑
❑
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
❑
0 ❑
❑
8. Do any of the structures lack adequate markers as required by the permit? (Not applicable
❑
MEI
❑
to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑
M ❑
❑
maintenance or improvement?
Waste Application
Yes No Na No
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ 0 ❑ ❑
maintenance or improvement?
11. Is there evidence of incorrect application?
❑ 0 ❑ ❑
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
❑
PAN?
❑
Is PAN > 10%/10 lbs.?
❑
Total Phosphorus?
❑
Failure to incorporate manure/sludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
page: 3

4 •
Permit: AWS820136 Owner - Facility : Murphy -Brown LLC Facility Number: 820136
Inspection Date: 10/23/14 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Waste Application
Yes No Na No
Crop Type 1
Coastal Bermuda Grass
(Hay, Pasture)
Crop Type 2
Small Grain Overseed
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Autryville
Soil Type 2
Johns
Soil Type 3
Wagram
Soil Type 4
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste
❑
❑
❑
Management Plan(CAWMP)?
15. Does the receiving crop and/or land application site need improvement?
❑
0 ❑
❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
❑
0 ❑
❑
determination?
17. Does the facility lack adequate acreage for land application?
❑
❑
❑
18. Is there a lack of properly operating waste application equipment?
❑
0 ❑
❑
Records and Documents
Yes No Na No
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑0
❑
❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑
❑
❑
If yes, check the appropriate box below.
WUP?
[]
Checklists?
❑
Design?
❑
Maps?
❑
Lease Agreements?
❑
Other?
❑
If Other, please specify
21. Does record keeping need improvement?
❑
0 ❑
❑
If yes, check the appropriate box below.
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
❑
Weather code?
❑
Rainfall?
❑
Stocking?
❑
page: 4

Permit: AWS820136 Owner - Facility : Murphy -Brown LLC Facility Number: 820136
Inspection Date: 10/23/14 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents
Yes No No No
Crop yields?
❑
120 Minute inspections?
❑
Monthly and 1" Rainfall Inspections
❑
Sludge Survey
❑
22. Did the facility fail to install and maintain a rain gauge?
❑
❑
❑
23. If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment
❑
N ❑
❑
(NPDES only)?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
❑
❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check the
❑
E ❑
❑
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?
❑
0 ❑
❑
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
0 ❑
❑
Other Issues
Yes
No Na No
28. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑
0 ❑
❑
and report mortality rates that exceed normal rates?
29. At the time of the inspection did the facility pose an odor or air quality concern? If yes,
❑
■ ❑
❑
contact a regional Air Quality representative immediately.
30. Did the facility fail to notify regional DWQ of emergency situations as required by Permit?
❑
E ❑
❑
(i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility?
❑
0 ❑
❑
If yes, check the appropriate box below.
Application Field
❑
Lagoon / Storage Pond
❑
Other
❑
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or
❑
0 ❑
❑
CAWMP?
33. Did the Reviewer/Inspector fail to discuss reviewlinspection with on -site representative?
❑
N ❑
❑
34. Does the facility require a follow-up visit by same agency?
❑
0 ❑
❑
page: 5

■ Division of Water Resources
❑
Division of Soil and Wager Conservation
❑ Other Agency
Facility Number.
820136 Facility Status:
Active Permit: AWS820135
❑ Denied Access
Inpsection Type:
Compliance inspection
Inactive Or Closed Date:
Reason for Visit:
Routine
County: Sampson Region:
Fayetteville
Date of Visit:
12118/2013 Entry Time: 09:00 am
Exit Time: 10:00 am Incident #
Farm Name:
Ingold Sow Farm
Owner Email:
Owner:
Murphy -Brown LLC
Phone:
910-296-1800
Mailing Address:
PO Sox 487
Warsaw NC 28398
Physical Address:
672 Lisbon Bridge Rd
Garland NC 28441
Facility Status:
Compliant ❑ Not Compliant
Integrator: Murphy -Brown LLC
Location of Farm:
Latitude: 34' 48' 33" Longitude:
78' 29 44"
On the west side of SR 1134 approx..6 miles south of its intersection with Hwy 701 at Ingold, NC
Question Areas:
Dischrge & Stream Impacts Waste Col, Stor, & Treat Waste Application
Records and Documents Other Issues
Certified Operator: Wayne O Sanderson Operator Certification Number: 17903
Secondary OiC(s):
On -Site Representative(s):
Name Title Phone
24 hour contact name
Mike Ammons Phone:
On -site representative
Mike Ammons Phone
Primary Inspector:
Robert Marble Phone:
Inspector Signature:
Date:
Secondary Inspector(s):
Inspection Summary:
page: 1

Permit: AWS820136 Owner - Facility : Murphy -Brown LLC Facility Number: 820136
Inspection Date: 12/18/13 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations Design Capacity Current promotions
Swine
Swine - Farrow to Wean
Swine - Feeder to Finish
Swine - Wean to Feeder
Total Design Capacity:
Total SSLW:
Waste Structures
Disignated Observed
Type Identifier Closed Date Start Date Freeboard Freeboard
Lagoon 1
page: 2

4 %
Permit: AWS820136 Owner - Facility : Murphy -Brown LLC Facility Number: 820136
Inspection Date: 12/18/13 Inppection Type: Compliance Inspection Reason for Visit: Routine
Discharges & Stream Impacts
Yes
No Na No
1. Is any discharge observed from any part of the operation?
❑
0 ❑
❑
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
❑ M
❑
b. Did discharge reach Waters of the State? (if yes, notify DWQ)
❑
❑ ■
❑
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑
❑ 0
❑
2. Is there evidence of a past discharge from any part of the operation?
❑
❑
❑
3. Were there any observable adverse impacts or potential adverse impacts to Waters of the
❑
❑
❑
State other than from a discharge?
Waste Collection. Storage & Treatment
Yes
No Na Na
4. Is storage capacity less than adequate?
❑
■ ❑
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (l.eJ large
❑
M ❑
❑
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a
❑
E ❑
❑
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
❑
0 ❑
❑
8. Do any of the structures lack adequate markers as required by the permit? (Not applicable
❑
❑
❑
to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑
M ❑
❑
maintenance or improvement?
Waste Application
Yes No Na No
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ 0 ❑ ❑
maintenance or improvement?
11. Is there evidence of incorrect application?
❑ ❑ []
If yes, check the appropriate box below.
Excessive Ponding?
[]
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu. Zn, etc)?
❑
PAN?
❑
Is PAN > 10%I10 lbs.?
❑
Total Phosphorus?
❑
Failure to incorporate manure/sludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
page: 3

Permit: AWS820136
Owner - facility : Murphy -Brown LLC Facility Number: 820136
Inspection Date: 12/18/13
Inppection Type: Compliance Inspection Reason for Visit: Routine
Waste Application
Yes N9Na Ne
Crop Type 1
Coastal Bermuda Grass
(Hay, Pasture)
Crop Type 2
Small Grain Overseed
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Autryville loamy sand, o to
6% slopes
Soil Type 2
Johns fine sandy loam
Soil Type 3
wagram loamy sand, o to
6% slopes
Soil Type 4
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste
❑
m ❑
❑
Management Plan(CAWMP)?
15. Does the receiving crop and/or land application site need improvement?
❑
❑
❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
❑
0 ❑
❑
determination?
17. Does the facility lack adequate acreage for land application?
❑
0 ❑
❑
18. Is there a lack of properly operating waste application equipment?
❑
0 ❑
❑
Records and Documents
Yes No No No
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑
0 ❑ ❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑
0 ❑ ❑
If yes, check the appropriate box below.
WUP?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Lease Agreements?
[]
Other?
❑
If Other, please specify
21. Does record keeping need improvement?
❑
❑ ❑
If yes, check the appropriate box below.
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
❑
Weather code?
❑
page: 4

Permit: AWS820136 Owner - Facility : Murphy -Brown LLC Facility Number:
820136
Inspection Date: 12/18/13 Inpsection Type: Compliance Inspection Reason for Visit:
Routine
Records and Documents
Yes
No No No
Rainfall?
❑
Stocking?
❑
Crop yields?
❑
120 Minute inspections?
❑
Monthly and 1" Rainfall Inspections
❑
Sludge Survey
❑
22, Did the facility fail to install and maintain a rain gauge?
❑
■ ❑
❑
23. If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment
❑
❑
❑
(NPDES only)?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
❑
❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check the
❑
❑
❑
appropriate box(es) below:
Failure to complete annual sludge survey
❑
Failure to develop a POA for sludge levels
❑
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?
❑
E ❑
❑
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
E ❑
❑
Other lssues
Yes No No No
28. Did the facility fail to property dispose of dead animals within 24 hours and/or document
❑
E ❑
❑
and report mortality rates that exceed normal rates?
29. At the time of the inspection did the facility pose an odor or air quality concern? If yes,
❑
E ❑
❑
contact a regional Air Quality representative immediately.
30. Did the facility fail to notify regional DWQ of emergency situations as required by Permit?
❑
0 ❑
❑
(i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility?
❑
0 ❑
❑
If yes, check the appropriate box below.
Application Field
❑
Lagoon / Storage Pond
❑
Other
❑
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or
❑
E ❑
❑
CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑
E ❑
❑
34. Does the facility require a follow-up visit by same agency?
❑
0 ❑
❑
page: 5

Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: • Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 1 Arrival Time: 2; Departure Time: Ot :0,7 County: . 6
Farm Name:L��yO �d S701A) Fit f-M Owner Email:
Owner Name: Kj./La L Phone:
Mailing Address:
Physical Address:
Region: 05'"
fin.
Facility Contact: 1 � i I6 y i d t15 Title: Phone:
Onsite Representative: 14 Integrator: Mu,*yL -.bnaidw _
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current` Design Current
s. 'ter"
Swine Capacety Pop Wet Poultry Capacr4ty Pad.
Design Current
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Dairy Calf
Wean to Feeder
Non -La er
Feeder to Finish
1
Design
D , P.oWt . Ca aei
"'
Current
P,o .m
Daig Heifer
Farrow to Wean
Farrow to Feeder
D Cow
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Boars
Other ,�_
L_j0thcr
Non -La ers
Beef Feeder
Pullets
Beef Brood Cow
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1 _ Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes
No
❑ NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
0 Yes ❑ No
❑ Yes [PNo
❑ Yes No
E�NA
❑NE
❑NA
ONE
❑NA
❑NE
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection: 3C 17
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
P No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[-]No
P NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3i k
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large flees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
®No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
�`
9. Does any part of the waste management system other than the waste structures require ❑ Yes T' � No [DNA ❑ 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): U_f Q�,5 �72vr. �a�uk'e-i I � X!.'L4 ' [J�},Q w-xiq
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ® No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination? i
IT 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
T
❑ NA
❑ NE
Ree uired 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 yjPp No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I ° Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Condnued

Facility Number: Date of Inspection: 3 [ 2
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ 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 P No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
[] NA
❑ 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
10 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
® No
0 NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other�comments. r
Use drawings of facility to better exulain situations fuse additional naves as necessarvl.
'1
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: 31 Z
2,14.12011

- Divvision of Water Quality -
s Facility Num.lter - ® Division of Soil and Water Conservation
® Other Agency IN 0
type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: *Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: �� County: �.c fd�Region: /�0
Farm Name:r.0�c>pw M Owner Email:
Owner Name: O►pon Phone:
Mailing Address:
Physical Address:
Facility Contact: M,`;&e Title: Phone:
6�
Onsite Representative:
Certified Operator:
Integrator: �U/,%�yg y.,jtd
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design
Current,:
Design
Current -
Design Current
Swine
Ca aci
Po" WetPoultry
Capacity
Pop
Cattle Capacity Pap.
Wean to Finish
La er
Da Cow
Wean to Feeder
D
RKon-La er
Dairy Calf
Feeder to Finish
6
'"
Dairy Heifer
Farrow to Wean
fr
5 �
Design
Current
D Cow
Farrow to Feeder
13 P16 ult :
Ca achy
P■o - ..
Non -Da -
Farrow to Finish
La ers
Seef Stocker
Gilts
Non -Layers
113eef Feeder
Boars
M Pullets
Beef Brood Cow
x Turkeys
Other
m Turkey Poutts
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
R] NA
❑ NE
❑ Yes
❑ No
[2 NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
�] No
[] NA
❑ NE
❑ Yes
No
[] NA
❑ NE
Page 1 of 3 21412011 Continued

[Fuility Number: - Date of Inspection: X70 /
� 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes "No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [—] No 0 NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes §d 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 P No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes P No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window []Evidence of Wind Drift [:]Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):�
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [p No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [P] No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable D Yes Qg No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes O No DNA ❑ 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? E] Yes [W 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 [7j 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 LV
No
[] NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facilitv Number: - 19i Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the pernut? ❑Yes �9 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [)a No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge Ievels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
No
❑ NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
1p No
❑ NA
❑ NE
❑ Yes
M No
❑ NA
❑ NE
❑ Yes
Ep No
❑ NA
❑ NE
❑ Yes
U No
❑ NA
❑ NE
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 ft No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [—]Yes Qg No ❑ NA ❑ NE
Comments (refer to question #I). Explain any YES answers and/or any additional recommendations or: any other cannmeuts:
Use drawutt�s-of facility to better explain situations (use additional pages as necessarv).
, P"e4S rp✓'� -� 114�t r.
5.A 7/iO, ,
Reviewer/Inspector Name: 6V_�_ Phone:
Reviewer/Inspector Signature: Date:
Page 3 of 3 4/2011

Al
0
36
J
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 ❑ Denied Access
Date of Visit: Arrival Time: 03 1 OOOVv4 Departure Time: b3.' County: u Region:
Farm Name: (I6101�B� +u _ Owner Email:
M �_j..
Owner Name: — K LLC Phone:
Mailing Address:
Physical Address:
Facility Contact: , l _ BY1rl S Title: Phone No:
Onsite Representative: N Integrator:
Certified Operator: + sue+ Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: o Longitude: ❑ e = ,
Design Current
Design Current
Design Current
Swine C*apacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
El Dairy Cow
Wean to Feeder
❑ Non -Layer
❑ DairyCalf
Feeder to Finish
El Dairy Heifer
Farrow to Wean
ry DPoultry
El Dry Cow
• Farrow to Feeder
El Layers
Non-Dairy
❑ Farrow to 1~ finish
❑Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
El Boars
El Pullets
El Beef Brood Cowl
❑ Turke s
" He
❑ Other
10 Turkey Poults
❑
Number of Structures: D
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d_ Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3_ Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes P No ❑ NA ❑ NE
❑ Yes
❑ No
[PNA
❑ NE
❑ Yes
❑ No
NA
❑ NE
NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
ElYes
No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

s w
Facility Number:
Date of Inspection 1 IU
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes PNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
P NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 0
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes [ No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes �9 No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA [:IN E
(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 [ LNo ❑ NA ❑ NE
maintenance/improvement?
1. Is there evidence of incorrect application? If yes, check the appropriate box below. [:]Yes Yy 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_W,,innd_ ,Drift ❑ Application Outside of Area
12. Crop type(s) �i1rw' a _GmS `sly ��'�`� � [fYr�I a�W_Lta _
13. Soil type(s) AA
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
PNo
❑ 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
0 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
Comments {refer.to question,#)�xplai4 any YES answers and/or any'recommendations or any other comments.
Use drawings of facility to bett&Oeif6iain situations. (use additional pages as+necessary, a
4 to �-810� •
ector Name dj 3� P Phone:
ReviewerAns
Reviewer/Inspector Signature: Date: 0
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection 10
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes tw No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NE
the appropriate box. ❑ W`Up ❑ Checklists ❑ Design ❑ Maps ❑ b Other AP
p
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P, 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25_ Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
N No
❑ NA
❑ NE
❑ Yes
❑ No
P NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
1P No
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
Q2 No
❑ NA
❑ NE
Page 3 of 3 12128104

Mailing Address:
Physical Address:
t
Facility Contact: '�5 Title:
U
Onsite Representative: P
Certified Operator:
Back-up Operator:
Phone No:
Integrator: U
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: EDo =1 1 ="
longitude: = o = * =
DesigM—urrent
Design
Current
Design Current
ulation
Wet Poultry Capacity
Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
El Dairy Calf
❑ Dairy Heifer
Feeder to Finish
C)
Farrow to Wean
Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Dry Poultry
❑ Layers
❑ Non -Layers
ElPullets
❑ l urke s
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑Beef Feeder
❑ Beef Brood Co
Other -, y:.
❑ Other
❑ Turkev Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes P9 No ❑ NA ❑ NE
❑ Yes ❑ No P NA
❑ NE
❑ Yes ❑ No IFNA
❑ NE
❑ Yes ❑ No ONA
❑ NE
❑ Yes T No ❑ NA
[--IN E
❑ Yes 11PNo ❑ NA ❑ NE
12128104 Continued

FacilityNumber:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes *No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No RNA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as 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?
]I. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
In 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 [I Evidence of Wind Drift El Application Outside of Area
12. Crop type(s) ` q LS Q AQ, ie:1 QU2�
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[ No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes]
{
No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
1P No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA ❑ NE
Comments (refer to question. #) E pla n any YES answers and/or any recomme dah ns or'any other coinments.
,
Use drawtn s'of facHi to better' ex "lain situations. use additional a es as ne�eessa "
g ty P ( P g ry)v
Reviewer/Inspector Name ,�j Phone. 0� 37G0
Reviewer/Inspector Signature: Date:11
12178104 Continued

k
Facility Number: — 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 El NE
El �El appropriate box. p Checklists ElDesign ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Op4o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ic/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes ftnNo
❑ Yes No
❑ YeslNo
No
❑ YesNo
❑ YesNo
❑ Yes
❑ NA ❑ NE
❑ NA ❑ NE
❑NA [I NE
El NA El NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
K No
❑ NA
❑ NE
❑ Yes
91 No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
W No
❑ NA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
12128104

J
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 ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: %OQ County:` n4 -Soi
Farm Name: 37—A qa[d QQ59t% FZ4-i%N Owner Email:
Owner Name: M114caku~L7 �ri� �� Phone:
Mailing Address:
Physical Address:
Region: EAQ
t
Facility Contact f —Title: Phone No:
Onsite Representative: --_ ,J,� 'r Integrator: _AAlt�� _ 6�w ki
Certified Operator: RI'lard a d 15m Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = a = L = it Longitude: ❑ a = i =
mill`Design Current
Swine Capacity Population
"'Design Current Design Current
WetaPoultry Ca�aciijl'opulation Cattle Capacity Population
❑ an to Finish
❑ La er:7
❑ Dairy Cow
❑ an to Feeder
-Layer
+_
❑ Dairy Calf
Feeder to Finish-
❑ Dairy Heifer
D ❑ Cow
`" '" "" ❑ Non
Farrow to Wean
Farrow to Feeder
❑ La ers
-Dairy
❑ Farrow to Finish
❑ Beef Stocker
on -Layers
El Pullets
❑ Turkeys
El Beef Feeder
❑ Gilts
❑ Boars
❑ Beef Brood Cow
-� -.
Otherr
❑ Other
-
Number of Structures:
❑ Turkey Poults
100ther
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
P No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
r NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
W 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
❑ No
�] NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes '1PNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
❑ NA
❑ NE
other than from a discharge'?
nNo
Page I of 3
12128104
Continued

Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
❑ Yes o ❑ NA ElNE
❑ Yes flZo 6 NA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
❑ No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
��Ciqq]
iL7 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
1PNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc_)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12.
Crop type(s) 1..0a$Q C-tia &CIRS L41� ' —t-69 ") SM • `r d
13.
Soil type(s) Az6 J`- d tQ —�, _ �K S `�b �7c w. -ttila B
14_
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
I$ No
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
[ONo
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
1�3 No
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
MNo
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
W No
❑ NA ❑ NE
Reviewer/inspector Name
Phone:
Reviewer/Inspector Signature:
Page 2 of 3
Date:
12128104 Continued

� h
Facility Number: S p� — ��(p Date of Inspection ` " �'
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes qlNo ❑ NA ❑ NE
the appropirate box. ❑ VVUp ❑ Checklists ❑ Desig
n ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes & No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking Cl 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
[PNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
A No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
0§No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Q,t�TNo
❑ NA
❑ NE
Did the facility fail to have an actively certified operator in charge?
❑ Yes
bg26. No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[NNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
W No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
RNo
❑ 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
Page 3 of 3 12128104

Division of Water Quality
Facility Number f 3p O Division of Soil and Water Conservation
O Other Agency
Type of Visit 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 ❑ Denied Access
Date of Visit: $ Z- Arrival Time: Departure Time: •' 3 County: _.5,7,,lSQ A) Region: D
Farm Name: —+Ma U SOU) &y0v► Owner Email:
Owner Name: ` h Phone:
Mailing Address:
Physical Address:
Facility Contact: h��l Sr"�+�n Title: Phone No:
Onsite Representative:
Certified Operator: It ��
Back-up Operator: _ M C' of` t "a'rer�S
Location of Farm:
Swine
Integrator• 64Le.r 12+�� ✓}r1
Operator Certification Number: Q6`�'�
Back-up Certification Number: _ i98 49 1
Latitude: [= o ❑ [ ❑ " Longitude: [= u = d
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
ElLa er
❑ Non -Layer
❑ Wean to Finish
Wean to Feeder
480
Other
❑ Other
Dry Poultry
Non -La
Pullets
Turkevs
Pou
Design Current I
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ElApplication Field ElOther
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 R!PNo ❑ NA ❑ NE
❑ Yes
❑ No
0 NA
❑ NE
❑ Yes
❑ No
RNA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
bNo
❑ NA
❑ NE
❑ Yes
�allo
❑ NA
❑ NE
12128104 Continued

Facility Number: /
Date of Inspection X
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 10No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No F] NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 55 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 0 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 E] No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the pen -nit? ❑ Yes
IR 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 El Yes
MAL5b No
El NA El NE
maintenance or improvement?
Waste Aimplication
10. Are there any required buffets, setbacks, or compliance alternatives that need ❑ Yes
M No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
JD 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 Drifl ❑ Application Outside/of Area
12. Crop types) nnq (6�zt-zo SNnQ (f �iLir 0 -e�[
-
13. Soil type(s) 61 J O
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
[S 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
'Ej No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
9 No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
W No
❑ NA ❑ NE
Comments (refer to question ft 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):
AL
T
Reviewer/Inspector Name R&A10Aj Phone: A9)V, _V0a
Reviewer/Inspector Signature: Date: r%
12128104 Continued

Facility Number: — 13 Date of Inspection B 9
Re uired 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 ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes do ❑ 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
14 No
❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
99 No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
M No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
E9 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 securea, phosphorus loss assessment (PLAT) certification?
❑ Yes
4 No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
1P 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
PS 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
KI No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

e
Type of Visit & Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine O Complaint 0 Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: 10 ob Arrival Time: % Departure Time: D/,� County:
Farm Name: SOLA) raCM Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: P 5"
Certified Operator:
Back-up Operator:
Phone No:
Integrator -
Operator Certification Number:
Back-up Certification Number:
Region:
Location of Farm: Latitude: = o = I = u Longitude: E--] o = , ❑ "
Desi -n Current
g
Des' n Current
igri
Design Current
Swine Capacity Population
Wet�Poultry
Capacity Population
Cattle e; ".
Capacity Population
❑ Wean to Finish
❑ La er
❑Dai Cow
Wean to Feeder
4530
❑Non -La er
❑Dai Calf
Feeder to Finish
El Dairy Heifer
Farrow to Wean Dry Po:ltry
❑ Dry Cow
❑ Farrow to Feeder
'`
❑ Non-Dai Ey
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
El Gilts
❑ Non -Layers
❑Beef Feeder
El Boars
El Pullets
❑Beef Brood Cowl
❑ Turkeys
❑ Turkey Poults
,
❑ Other
❑ Other
Numtier{af'Structures:
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
❑ No
W NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
1P 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
❑ No
10 NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
(p No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: — Date of Inspection a 06
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes N No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No M NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
ldentifier.
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes &No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes VJ 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 RSNo ❑ 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 99 No ❑ NA ❑ NE
maintenance or improvement?
Waste Auolication
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 ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [:IPAN > 10% or ] 0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
�. r
12. Croptype(s)fn"' m _Z2�� Sr^af [ �^•` t�p'ti/Sy�-Gr
13. Soil type(s) 14-ill !::�b 1a B
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes W 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 OgNo ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendahoos or'any.other comments
Use drawings.of facility to better explain situations. (use additional pages as necessary):��
Reviewer/Inspector Name —f. — — - " 1 Phone: L11199)3
Reviewer/Inspector Signature: Date: lAlla
Paee 2 of 3
12128104 Continued

Facility Number: c?,-/,3 Date of Inspection ! 3!
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Q1 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes W No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists El Design El Maps El 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 I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24_ Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
® No
[:1 NA
❑ NE
❑ Yes
ff] No
❑ NA
❑ NE
❑ Yes
[D No
❑ NA
❑ NE
❑ Yes
09 No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
figNo
❑ NA
❑ NEB
❑ Yes
[24 No
❑ NA
❑ NE
❑ Yes
M No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
[59 No
❑ NA
❑ NE
Page 3 of 3 12128104

r
Type of Visit 8 Compliance inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit O Routine Q Complaint Q Follow up Q Referral Q Emergency Q Other ❑Denied Access
Date of Visit: OS' O Arrival Time: (> Departure Time: ; /5 County: Soh Region: EAQ
Farm Name: _ J_!a aald Fdywi Owner Email:
V
Owner Name: +' t. F14YA, S T_ Phone:
Mailing Address: _j C) T? _ S D 5-e_ ,!_i _ _Al C_
Physical Address:
Facility Contact: Qe'k-t,_ f7 a ; 4 Title:
Onsite Representative: f�c vet Sim �11-1
Certified Operator: _ iCeaL
Back-up Operator:
Phone No: *Q -2 02 -.2./I /
Integrator:
Operator Certification Number: c2 (a .6 G 4!�
Back-up Certification Number:
Location of Farm: Latitude: = e 0 I =" Longitude: 0 ° = 4 0
v'Design Currentf
`ak Design Current
;�Dign Current
Capacity ?P�opul tton
V►'et Poultry Capacity
Population
Cap
to Finish
F
❑ La er
to Feeder a y O
❑Non -La et
❑Dai Calf
r to Finish r1
❑ DairyHeifei
f
Drv�Poult o ",
❑ D Cow
,�,,.
El Non -Dairy
❑ La ers
El Beef Stocker
❑ Non -Layers
❑Beef Feeder
❑ Pullets
❑ Beef Brood Cow
❑Yorke Points
❑ Other
to Wean
to Feeder
to Finish
Discharges &Stream Impacts
1. Is any discharge observed from any part of the operation?
❑Yes
gNa
❑ NA
❑ NE
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made?
❑Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
El Yes
❑ 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)
El Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
No
❑ NA
El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
,,
L��'N//o
❑ NA
❑ NE
other than from a discharge?
12/28/04
Continued

1.
Facility Number: ft — / 8 (, I Date of Inspection o 5 D(
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. if yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ®No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes YNo ❑ NA ❑ NE
❑ Yes ❑`No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 02(No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
EgNo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑ Yes
[yNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ElE Yes
��,,/
� o
❑ NA ❑ NE
maintenance/improvement?
i 1. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
,,�__,,
191<0
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window Evidence of Wind Drift ❑ Application Outside of Area
/❑
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
/
P o
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
[g,&o
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination[:] Yes
ERI�o
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
PrNo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
B No
❑ NA ❑ NE
Reviewer/Inspector Name Ii` Q,; '� Phone: U $r
Reviewer/Inspector Signature: Date: —
12/28/04 Continued

Facility ]Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes B'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 ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ ❑ Was a Analysis ❑ Seil'-rnafyx s ❑ � A
❑ Rainfall- ❑ StoGliioga - ❑ Crop Yield ❑ 120 Minute [nspections ❑ Monthly and V Rain Inspections ❑ WkeetlwrCede
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 2io ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [91 o ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[a -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
[a'No
❑ NA
❑ NE
2T
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
�TO
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
EgKo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[R'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
[9,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
E4-lq[o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
9-NO
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[i]�lo
❑ NA
❑ NE
AddrhonalgCotnments and/or;Drawings
l2/2"4
l2/2"4

Type of Visit *Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit o Routine O Complaint O Follow up O Emergency Notification O Other p Denied Access
F_ Facility Number
Date of Visit: % 1 0 Tune:
Z
O Not Operational O Below Threshold
Permitted jWCertMed © Conditionally Certified © Registered Date Last Operated or Above Threshold: _.. _. _. ..
=►n o ids SQ W
Farm Name:..........._......�.........._...W.....-•---DD—__.fir rv� .......�. ..-__._.......�__ Caunty:..._.....�1.1�!.�_S�Q..�4.�...._.......�................
Owner Name: _. .lrl r. �. T.�.11'4i t�.t.�...................... ........... . Phone No: _. _'t 0
Mailing Address:
Facility Contact: .._. 5. +.:GrA►�s�i^ ..siy Title: ... ............................ ...._.....� . Phone No:
Onsite Representative:...
Certified Operator .......... �t�p � S � ' f '� Operator Certification Number: •2 � SG (�_�_
Location of Farm:
Pq Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude a 4 '4 Longitude • 4 is
Swine =
.Cap
Desiign SCni
F�
Wean to Feeder
qS6
q so=
❑ Layer
der to Finish
Non -Layer
Farrow to Wean
3 to
3 :
-
Farrow to Feeder
Other
Farrow to Finish
t'. Toial DiSij
Gilts
Boars
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
c><y 572 2
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes P(No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes [A -No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes PINO
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 06No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 5
Identifier: ........._.. ........... ............ ............... _-
Freeboard (inches):
12112103 Continued

Facility. Number: Z — 3 (p Date of Inspection i
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
❑ Yes
[,No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes
XNo
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
9 No
8. Does any part of the waste management system other than waste structures require maintenancerimprovement?
❑ Yes
KNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
[] Yes
ZNo
elevation markings?
WasteApphcation
10. Are there any buffers that need maintenancefunprovement?
❑ Yes
K[No
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
7kNo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type er r,L v
13. Do the receiving crops differ with those designated inle Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
59 No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
M No
b) Does the facility need a wettable acre determination?
❑ Yes
10 No
c) This facility is pended for a wettable acre determination?
❑ Yes
KNo
15. Does the receiving crop need improvement?
❑ Yes
RNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
PINo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
❑ Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
05No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
09 No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes
jK No
Air Quality representative immediately.

Facility Number: 8z — (S(V I Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes %No
22. Does the facility fail to have al corn onents of the Certified Animal Waste Management Plan readily available?
(ie/ Wl�hecklists0esigma , etc.)
❑ Yes
RNo
23. Does record keeping need improvement? If yes, check the appropriate box below.
[I Yes
$No
❑ Waste Applicati�❑ Freeboa>�❑ Waste Analysj9� ❑ Soil Sampling/
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
5jNo
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
JkNo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
C.No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
KNo
28. Does facility require a follow-up visit by same agency?
❑ Yes
CKNo
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
4 No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
KYes
❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
J4 No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
§§,No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
P,No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
KNo
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
5[No
❑ Stocking Form❑ Crop Yield For*--'[] RainfalV❑ Inspection After 1" Raiq
❑ 120 Minute Inspectiont/❑ Annual Certification Form/
12112103

\ � �;` J3 Division of Soil and Water Conservation Other Agency
,
Division of Water Quality
10 Routine O Comnlaint O Follow-un of DIVO insomtion 0 Follow-un of DSWC review O Other I
Date of Inspection
Facility Number
Time of Inspection L2.4 hr. (hh:mm)
13 Registered Certified 0 Applied for Permit fiLPermitted JE3 Not Operational I Date Last Operated :............ •,........
Farm Name: _ Jf-.17ry1�$r�a7 .......... _..............
. G��.......��..���� ......... County : .... .............
� q
Owner Name: LFiEI�kl. Phone No: I d — S1%-.-.1'� ._.........
_...._ �- _... .�...._.........._.._....... ..,1............... .......
Facility Contact: ,,,,,•...1.tL!<{..I....... k.�#i..l! ,P Title: Phone No: qla ..
........... .............................................................
Mailing Address: ................-...p`................`�9 �P.........1//...... .............o.....n.....
�Wi� _ _ ....
P.h1.............. ..... Onsi#e Representative:-.---_-` a ' 6 q./•,�.�,�{Z��j ,� �'t✓ � �•• �l%j
Certified Operator; ... _ .... ARK.1 i at r�1D ,�.___ . ............... Operator Certification Number ....... ..... ..........
Location of Farm:
Latitude O0C 4 46 Longitude • ` "
Design : Current Design Current : x= Design --Current
Swine Capacity Population .:Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer JE1 Dairy
V ❑ Feeder to Finish ❑Non -Layer ❑Nan -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Othert
Farrow to Finish Total Design Capacity; S a
Gilts
',,.-'[]Boars Total SSLW
Number of Lagoons / Holding Ponds ❑ Subsurface Drains Present][[] Lagoon Area I0 Spray Field Area
y ❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes ONO
2. Is any discharge observed from any part of the operation? ❑ Yes Ig No
Discharge ori-inated at: ❑ Lagoon ❑ Spray Field [I Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes P No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes JA No
c. if discharge is observed, what is the estimated flow in ,aVmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes MNo
5. Does any pan of the waste management system (other than Iagoons/holding ponds) require ❑ Yes R No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes qNo
7. Did the facility fail to have a certified operator ir responsible charge? ❑ Yes ANo
7/25/97
Continued on back

Facility Number: g01— ISk
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes 131 No
Structures (Lagoons,Holding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ............�............................_...............
Freeboard(ft):..................... ........ _... I ................... _............................. ...... . .... W......W.._._..................................
10. Is seepage observed from any of the structures? ❑ Yes allo
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes FjNo
12. Do any of the structures need maintenance/improvement? Od 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 [gNo
Taste Amlication
14. Is there physical evidence of over application? ❑ Yes No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type Jam..._....... /i.[rt ....................u'........�...._...... ......_ ... -
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes No
g
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
IffNo
18.
Does the receiving crop need improvement?
❑ Yes
Vet No
19.
Is there a lack of available waste application equipment?
❑ Yes
J No
24.
Does facility require a follow-up visit by same agency?
;9 Yes
❑ No
21.
Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
XNo
22.
Does record keeping need improvement?
❑ Yes
No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
® No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
WNo
0 No -violations or deficiencies were: noted -during this,' visit. .You.will receive no ftirther
correspondence about this. visit:.... .. , .. .
CommentsIrefer to question #): Explain any' avers. an& `airy recomntendattons or "in"
other com nea#s:
UseMdrawzngs of.facility tci better explain situations (use add+honal pages as necessary? �; �
..,.> .
VnZ*�� � � ��
RevleWCr/inspector Name
F--q aura - .,id N� � hai�.,,�i�o vF,•„s.,
Reviewer/Inspector Signature: 1„� �i�ayti Date:A 3 al /Ile