090171_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Quaff

0 Division of Water Resources
❑ Division of Soil and Water Conservation
Other Agency
Facility Number:
090171 Facility Status:
Active Permit: AWS090171
❑ Denied Access
Inpsectlon Type:
Compliance Inspection
Inactive Or Closed Date:
Reason for Visit:
Routine
County: Bladen Region:
Fayetteville
Date of Visit:
03/31/2017 Entry Time: 04:00 pm
:exit Time: 5:00 pm Incident 0
Farm Name:
Farm 5710
Owner Emall:
Owner:
Murphy -Brown LLC
Phone:
910-296-1800
Mailing Address:
PO Box 487
Warsaw NC 28398
Physical Address:
260 Hog Bay Rd
Bladenboro NC 28320
Facility Status:
Compliant Not Compliant
Integrator. Murphy -Brown LLC
Location of Fenn:
Latitude: 34" 34' 47" ' Longitude:
78° 48' 15"
approx. 2 miles east of SR 1100 at end of SR 1126
Question Areas:
Dischrge & Stream Impacts Waste Col, Stor, & Treat
Waste Application
Records and Documents Other lssues
Certified Operator: Hubert S Freeman
Operator Certification Number: 995231
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(a):
Inspection Summary:
page: 1

permit: AW5090171 Owner - Facility: Murphy -Brown LLC Facility Number: 090171
Inspection Date: 03/31/17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations Design Capacity Current promotion*
Swine
Swine - Farrow to Wean 2,400
Total Design Capacity: 2,400
Total SSLW: 1,039,200
Wants Structures,
Dislgnated Observed
Type Identifier Closed Data Start Data Freeboard Freeboard
Lagoon 09-171-1
Lagoon 1 19.00 36,04
page: 2

Permit: AWS090171 Owner - Facility: Murphy -Brown LLC Facility Number: 090171
Inspection Date: 03/31/17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
DIscharnes & Stream Impacts
Yes
No_Na_Ne
1. is any discharge observed from any part of the operation?
❑
❑
❑
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
❑
❑
b. Did discharge reach Waters of the State? (if yes, notify DWQ)
❑
❑
❑
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?
❑
❑
❑
3. Were there any observable adverse impacts or potential adverse impacts to Waters of the
❑
❑
❑
State other than from a discharge?
Waste Collection. 5torane & Treatment
Yes
No Na No
4. Is storage capacity less than adequate?
❑
❑
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (Le./ large
❑
0 ❑
❑
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?
❑
❑
❑
8. Do any of the structures lack adequate markers as required by the permit? (Not applicable
❑
0 ❑
❑
to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑
❑
❑
maintenance or improvement?
Waste Application
Yes No No No
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ ❑ ❑
maintenance or improvement?
11. Is there evidence of incorrect application?
❑ M ❑ ❑
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: AWS090171 Owner - Facility : Murphy -Brown LLC Facility Number: 090171
Inspection Date: 03/31/17 Inppection Type: Compliance Inspection Reason for Visit: Routine
Waste Aaolication
Yee No Na No
Crop Type 1
Coastal Bermuda Grass
(Pasture)
Crop Type 2
Fescue (Pasture)
Crop Type 3
Matue (Pasture)
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Goldsboro sandy loam, o to
3% slopes
Soil Type 2
Lynchburg fine sandy loam
Soil Type 3
Rains fine sandy loam
Soil Type 4
Torhunte
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste
❑
E ❑
❑
Management Plan(CAWMP)?
15. Does the receiving crop and/or land application site need improvement?
❑
❑
❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
❑
■ ❑
❑
determination?
17. Does the facility lack adequate acreage for land application?
❑
❑
❑
18. Is there a lack of properly operating waste application equipment?
❑
E ❑
❑
ecords and Docu
19, Did the facility fail to have Certificate of Coverage and Permit readily available?
❑ 01113
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?
❑
Rainfall?
❑
page: 4

Permit: AWS090171 Owner - Facility : Murphy -Brown LLC Facility Number: 090171
Inspection Date: 03/31/17 Inssection Type: Compliance inspection Reason for Visit: Routine
ords and Docume
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
❑
❑ ❑
(NPDBS 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
❑0
❑ ❑
appropriate box(es) below:
Failure to complete annual sludge survey
❑
Failure to develop a PDA 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?
❑
❑ ❑
Other Issues
Yes
No No No
28. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑
❑
❑
and report mortality rates that exceed normal rates?
29. At the time of the inspection did the facility pose an odor or air quality concern? If yes,
❑
M ❑
❑
contact a regional Air Quality representative immediately.
30. Did the facility fail to notify regional DWQ of emergency situations as required by Permit?
❑
❑
❑
(i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility?
❑M
❑
❑
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 ❑ M ❑ ❑
CAWMP?
33. Did the Reviewer/Inspector fall to discuss review/inspection with on -site representative? ❑ 0 ❑ ❑
34. Does the facility require a follow-up visit by same agency? ❑ 0 ❑ ❑
page: 5

r ;
N Division of Water Resources
❑ Division of Soil and Water Conservation
❑ Other Agency
Facility Number:
090171 Facility Status:
Active Permit: AWS090171
❑ Denied Access
Inpsectlon Type:
Compliance Inspection
Inactive Or Closed Date:
Reason for Visit:
Routine
County: Bladen Region:
Fayetteville
Date of Visit:
07/28/2015 Entry Time: 08:00 am
Exit Time: 9:00 am Incident #
Farm Name:
Farm 5710
Owner Email:
Owner:
Murphy -Brown LLC
Phone:
910-296-1800
Mailing Address: PO Box 487 Warsaw NC 28398
Physical Address: 260 Hog Bay Rd Bladenboro NC 28320
Facility Status: 0 Compliant ❑ Not Compliant integrator: Murphy -Brown LLC
Location of Farm:
approx. 2 miles east of SR 1100 at end of SR 1126
Question Areas:
Dischrge & Stream Impacts
Records and Documents
Latitude: 34° 34' 47"
Longitude: 78° 48' 15"
Waste Col, Stor, & Treat Waste Application
Otherlssues
Certified Operator: John S Cain Operator Certification Number: 23570
Secondary OIC(s):
On-Slte Rep rosentative(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: AWS090171
Owner -Facility: Murphy -Brown LLC
Facility Number:
090171
Inspection Date: 07/28/15
Inpsection Type: Compliance Inspection
Reason for Visit:
Routine
Regulated Operations
Design Capacity
Current promotions
Swine
Swine - Farrow to Wean
2.400
Total Design Capacity:
2,400
Total SSLW:
1,039,200
Waste Structures
Disignated
Observed
Type
Identifier Closed Date start Date
Freeboard
Freeboard
Lagoon 09-171-1
Lagoon 1 19.00 48.00
page: 2

Permit: AWS090171 Owner - Facility : Murphy -Brown LLC Facility Number: 090171
Inspection Date: 07/28/15 1npsection Type: Compliance Inspection Reason for Visit: Routine
Diacharnes & Stream Impacts
Yos
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?
❑
❑ 0
❑
b. Did discharge reach Waters of the State? (if yes, notify DWQ)
❑
110
❑
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
❑ 0
❑
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
❑
❑
❑
State other than from a discharge?
Waste Collection Storage & Treatmen
Yes
No No Ne
A. 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 (Led large
❑
■ ❑
❑
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a
❑
❑
❑
waste management or closure plan?
7, Do any of the structures need maintenance or improvement?
❑
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
❑
❑
❑
maintenance or improvement?
Waste Application
Yea 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?
❑ ❑ ❑
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: AWS090171 Owner -Facility: Murphy -Brown LLC Facility Number: 090171
Inspection Date: 07/28/15 Inppection Type: Compliance Inspection Reason for Visit: Routine
Waste Application
Yes No Na No
Crop Type 1
Coastal Bermuda Grass
(Pasture)
Crop Type 2
Fescue (Pasture)
Crop Type 3
Matua (Pasture)
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Goldsboro
Soil Type 2
Lynchburg
Soil Type 3
Rains
Soil Type 4
Torhunta
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?
❑ M ❑
❑
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?
❑ M1313
Records and Documents
19, Did the facility fail to have Certificate of Coverage and Permit readily available?
❑
M ❑
❑
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?
❑
❑
❑
If yes, check the appropriate box below.
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
❑
Weather code?
❑
Rainfall?
❑
Stocking?
❑
page:
4

Permit: AWS090171 Owner - Facility : Murphy -Brown LLC Facility Number: 090171
Inspection Date: 07/28/15 Inppection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents
yos
No Na No
Crop yields?
❑
120 Minute inspections?
❑
Monthly and 1" Rainfall Inspections
❑
Sludge Survey
❑
22. Did the facility fail to install and maintain a rain gauge?
❑
0 ❑
❑
23. If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment
❑
■ ❑
❑
(NPDBS only)?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
E ❑
❑
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?
❑
❑
❑
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
❑
❑
Other Issues
Yes
No No Ne
28. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑
N ❑
❑
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?
❑
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 I 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 review/inspection with on -site representative?
❑
❑
❑
34. Does the facility require a follow-up visit by same agency?
❑
0 ❑
❑
page: 5

1
M Division of Water Resources
Division of Soil and Water Conservation
Other Agency
Facility Number:
090171 Facility Status:
Active Permit: AWS090171
❑ Denied Access
Inpsection Type:
Compliance Inspection
Inactive Or Closed Date:
Reason for visit:
Routine
County: Bladen Region:
Fayetteville
Date of visit:
10/21/2014 Entry Time: 09:00 am
Exit Time: 10:00 am Incident #
Farm Name:
Farm 5710
Owner Email:
Owner:
Murphy -Brown LLC
Phone:
910-296-1800
Malting Address:
PO Box 487
Warsaw NC 28398
Physical Address:
260 Hog Bay Rd
Bladenboro NC 28320
Facility Status:
Compliant El Not Compliant
Integrator: Murphy -Brown LLC
Location of Farm:
Latitude: 34' 34' 47" Longitude:
78° 48' 15"
approx. 2 miles east of SR 1100 at end of SR 1126
Question Areas:
Dischrge & Stream Impacts
Records and Documents
Certified Operator: John S Cain
Secondary OIC(s):
Waste Col, Stor, & Treat Waste Application
Other issues
Operator Certification Number: 23570
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

M 1\
Permit: AWS090171 Owner - Facility : Murphy -Brown LLC Facility Number: 090171
Inspection Date: 10/21/14 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations Design Capacity Current promotions
Swine
Swine - Farrow to Wean 2,400
Total Design Capacity: 2,400
Total SSLW: 1,039,200
Yili1extt Structures
Disignated Observed
Type Identifier Closed Date Start Date Freeboard Freeboard
agoon 09-171-1
agoon 1 19.00 44.00
page: 2

Permit AWS090171 Owner - Facility : Murphy -Brown LLC Facility Number 090171
Inspection Date: 10/21/14 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Discharsaes & Stream Impacts
Yos
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?
❑
00
❑
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 DWO)
❑
❑ 0
❑
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
❑
■ ❑
❑
State other than from a discharge?
Waste Collection, Storane & Treatment
Yos
No NJ -NJ
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,eJ large
❑
M ❑
❑
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
❑
0 ❑
❑
to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑
No
❑
maintenance or improvement?
Waste Application
Yon -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 Ibs.7
❑
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: AWS090171 Owner- Facility : Murphy -Brown LLC Facility Number
090171
Inspection Date: 10/21/14 Inppection Type: Compliance Inspection Reason for Visit:
Routine
Waste Applicaltion
Yes Ne_Na_Ne
Crop Type 1
Coastal Bermuda Grass
(Pasture) '
Crop Type 2
Fescue (Pasture)
Crop Type 3
Matua (Pasture)
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Goldsboro
Soil Type 2
Rains
Soil Type 3
Torhunta
Soil Type 4
Lynchburg
Soil Type 5
Woodington
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste
❑ E ❑
❑
Management Plan(CAWMP)?
15. Does the receiving crop and/or land application site need improvement?
❑ 0 ❑
❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
❑ ❑
❑
determination?
17. Does the facility lack adequate acreage for land application?
❑ ■ ❑
❑
18. Is there a lack of properly operating waste application equipment?
❑ E ❑
❑
Records and Documents
Yes
No No -No
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?
❑
E ❑
❑
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: AWS090171 Owner - Facility : Murphy -Brown LLC Facility Number.
090171
Inspection Date: 10/21/14 Inpsection Type: Compliance Inspection Reason for Visit:
Routine
Records and Documents
Yea 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?
❑
0 ❑
❑
23. If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment
❑
0 ❑
❑
(NPDES only)?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
0 ❑
❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check the
❑
❑
❑
appropriate box(es) below:
Failure to complete annual sludge survey
❑
Failure to develop a POA for sludge levels
❑
Non -compliant sludge levels in any lagoon
❑
List structure(s) and date of first survey indicating non-compliance:
2& 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?
❑
❑
❑
Other Issues
Yes No Na No
28. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑
M ❑
❑
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,
❑
M ❑
❑
contact a regional Air Quality representative immediately.
30. Did the facility fail to notify regional DWQ of emergency situations as required by Permit?
❑
❑
❑
(i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility?
❑
❑
❑
If yes, check the appropriate box below.
Application Pield
❑
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 review/inspection with on -site representative?
❑
❑
❑
34. Does the facility require a follow-up visit by same agency?
❑
❑
❑
page: 5

f
Division of Water Resources
Division of Soil and Water Conservation
❑ Other Agency
Facility Number: 090171 Facility Status, Active Permit: AWS090171 E Denied Access
Inppection Type: Compliance Inspection Inactive Or Closed Date:
Reason for Visit: Routine County: Bladen Region: Fayetteville
Date of Visit: 02/27/2013 Entry Time: 02:00 pm Exit Time: 2:30 pm Incident #
Farm Name: Farm 6710 Owner Email:
Owner: Murphy -Brown LLC Phone: [phone]
Mailing Address: PO Box 487 Warsaw NC 28398
Physical Address: 260 Hog Bay Rd Bladenboro NC 28320
Facility Status: N Compliant ❑ Not Compliant Integrator: Murphy -Brown LLC
Location of Farm:
approx. 2 miles east of SR 1100 at end of SR 1126
Latitude: 34' 34' 47"
Longitude: 78° 48' 15"
Question Areas:
Dischrge & Stream Impacts Waste Col, Stor, & Treat Waste Application
Records and Documents Other issues
Certified Operator: John S Cain Operator Certification Number: 23570
Secondary OIC(s):
On -Site Representative(s): Name Title Phone
24 hour contact name Mike Cudd Phone:
On -site representative Mike Cudd Phone
Primary Inspector: Robert Marble Phone:
Inspector Signature: Date:
Secondary Inspector(s):
Inspection Summary:
Records reviewed 2114113
Site visit 2127/13
page: 1

Permit: AWS090171 Owner - Facility : Murphy -Brown LLC Facility Number: 090171
Inspection Date: 02/27/13 Inssection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations Design Capacity Current promotions
Swine
Swine - Farrow to Wean 2,400
Total Design Capacity:
Total SSLW:
Waste Structures
Disignated Observed
Type Identifier Closed Date Start Date Freeboard Freeboard
i
Lagoon 09 171-1
Lagoon 1 19.00
page: 2

Permit: AWS090171 Owner - Facility : Murphy -Brown I.LC Facility Number: 090171
Inspection Date: 02/27/13 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Discharges & Stream Impacts
Y9e_N0__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?
❑
❑ 0
❑
b. Did discharge reach Waters of the State? (if yes, notify DWQ)
❑
❑ 0
❑
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑
❑ 0
❑
2. Is there evidence of a past discharge from any part of the operation?
❑
N ❑
❑
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
Yea
No No Ne
4. Is storage capacity less than adequate?
❑
■ ❑
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (Led large
❑
N ❑
❑
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a
❑
013
❑
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
❑
0 ❑
❑
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 Ibs,?
❑
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: AWS090171 Owner - Facility : Murphy -Brown LLC Facility Number: 090171
Inspection Date: 02/27/13 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Waste Application
Yes No No N�
Crop Type 1
Coastal Bermuda Grass
(Pasture)
Crop Type 2
Fescue (Pasture)
Crop Type 3
Matua (Pasture)
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Goldsboro
Soil Type 2
Rains
Soil Type 3
Torhunta
Soil Type 4
Woodington
Soil Type 5
Lyncnburg
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?
❑ ■ ❑
❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
❑ ■ ❑
.❑
determination?
17. Does the facility lack adequate acreage for land application?
[] ❑
❑
18. Is there a lack of properly operating waste application equipment?
❑ 0 ❑
❑
Records and Documents
Yes No No Ne
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑
❑ ❑
20, Does the facility fail to have all components of the CAWMP readily available?
❑
❑ ❑
If yes, check the appropriate box below.
WUP?
❑
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

F ?y
Permit: AWS090171 Owner -Facility: Murphy -Brown LLC Facility Number: 090171
Inspection Date: 02/27/13 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents
Xqn 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
❑
0 ❑
❑
(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
❑
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?
❑
0 ❑
❑
Other Issues
Yon No Nagle
26, Did the facility fall to properly dispose of dead animals within 24 hours and/or document
❑
■ ❑
❑
and report mortality rates that exceed normal rates?
29, At the time of the inspection did the facility pose an odor or air quality concern? If yes,
❑
❑
❑
contact a regional Air Quality representative immediately.
30. Did the facility fail to notify regional DWQ of emergency situations as required by Permit?
❑
❑
❑
(i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility?
❑
0 ❑
❑
If yes, check the appropriate box below.
Application Field
❑
Lagoon 1 Storage Pond
❑
Other
❑
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or
❑
0 ❑
❑
CAWM P?
33. Did the Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑
0 ❑
❑
34. Does the facility require a follow-up visit by same agency?
❑
N ❑
❑
page: 5

I'ype of Visit: W Compliance inspection U Vperation Review U Structure Lvatuation U I eclinicai Assistance
Reason for Visit: 4D Routine O Complaint O Follow-up O Referral 0 Emergency O Other O Denied Access
Date of Visit: `mot `J Arrival Time: M Departure Time: D : a?D County: 6 LArQ&j Region: go
Farm Name: ' Q LRrn Owner Email:
Owner Name:i<� Li-L_ Phone:
Mailing Address:
Physical Address:
Facility Contact: j k x'n yVA O h� Title:
I!
Onsite Representative: 1-0
�' /�,,
Certified Operator: 10kn L.fLN
Back-up Operator: M i� le, }A'rn✓��S
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: a3Q5Q'%®
Certification Number: ! QZ01 /
Longitude:
Design Current
Design
Current
Design
Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cuttle
Capacity
Pop.
Wean to Finish
La er
jDairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Qq00
esign
Current
Dry Cow
Farrow to Feeder
Dr, Poultry
Ca aci
P,a P.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layer
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Qthe
U
TurkeyPouets
El Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Vacility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes � No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [] No R NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 394
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) T
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
0 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
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
M 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 AcceptableCrop Window ❑/E�vidlence of Wind Drift ❑ Application Outside of Approved Area
rr r
12.Cro T es:
p Yp ()1 CRfR l?�'Q SS Lf a�t'�^�
r�
` h�
v
13. Soil Type(s): Gdek6vv-6 A. Gt10D —jn%p
t �j
14. Do the receiving crops differ from those designated in the CAWMP?
lel Yes
[P No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAW -MP readily available? If yes, check
❑ Yes
® No
❑ NA
❑ NE
the appropriate box.
T
❑WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Tr nsfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [� No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

d
�r
VA
Facility Number: C1. - rM jDate of Inspection:'IL !l
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 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 ©0 No ❑ NA ❑ NE
Other Issues T
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? TT""
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, frecboard 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 T No
[:]Yes V No
❑ Yes ® No
❑NA ❑NE
❑ NA ❑ NE
❑ 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
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
[ No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other commentv,'
Use drawings of facility to better explain situations (use additional pages as necessary).; Fk�
.5 �k j 'is (-,� co4 tte-44 5-111 li ( ,
Reviewer/Inspector Name: DIl4PJlrt` MU6if—
Reviewer/Inspector Signature:
Page 3 of 3
Phone: qr0' (33r33co
Date:
2/4/2Oil

Type of Visit: 40 Compliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: ®Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: 2: ounty: �_ Region: 1Q
Farm Name: .� f 1 0 ~� Owner Email:
Owner Name: (,lq�,. �yQl,ii h Z—1 l Phone:
Mailing Address:
Physical Address:
Facility Contact: A kf CjAdd Title: Phone:
4
Onsite Representative: Integrator:
Certified Operator: !I L ao" Certification Number: 2.100
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
Wean to Finish
can to Feeder
design
Capacity
Current Design C►arrant
Pop. Wetapacity Pop.
Poultmac
'WE Layer I I
Non -La er I
Cattle
Dairy Cow
Design
Capacity
Current
Pop.
Dairy Calf
DaiH Heifer
Feeder to Finish
Farrow to Wean
Da
Design Current
Dr, Poultr, Ca acit Po
La ers
D Cow
Farrow to Feeder
Farrow to Finish
Non-Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharees and Stream Imnacts
1. 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
® NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[A No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
P No
❑ NA
❑ NE
. of the State other than from a discharge?
Page I of 3 21412011 Continued

� .'TY�*"':.,.L'`., "�. � ..�;..�,r.,v,.i, n,y.�.,, r..,,��,�+.,-:r-�iryRaer^r'v""'n+.." •ds�t-i�_^'v.+� , .�,rL.,;�i'� _ -- - .. .. -. - .- r - ._ - -- -
0 Division of Water Quality
1 wcp+ity Number - 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: 0 Compliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Q Routine O Complaint 0 Follow-up O Referral 0 Emergency O Other O Denied Access
Date of Visit: x Arrival Time;
I
Departure Time: � ,� r �Q _County: Region:
Farm Name : �Owner Email:
Owner Name: w,-•1? , Phone:
Mailing Address:
Physical Address:
Fa cility Contact: A, kf CW Title:
r
4
Onsite Representative:
Certified Operator-, a ca'• 'x
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Phone:
Integrator:
Certification Number: %Q
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
1----]Non-Layer____
]lets
Other
Poults
Design Current
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)?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes R No ❑ NA ❑ NE
❑ Yes
❑ No
® NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
d. Does the discharge bypass the waste management system? (if yes, notify DWQ) ❑ Yes ❑ No R] NA ❑ NE
s•
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [ No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse'impacts to the waters []Yes No []'NA ❑ NE
of the State other than from a discharge?
r
f Page I of 3 h, _, , 21412011 Continued :�

Facili Number: - 77777 jDate of inspection: o212,7773
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[]Yes
PP No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
Qn NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: 1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 429 rr
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
"�o 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
K] 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
0 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[—]Yes
rp 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
;U No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
M No
❑ NA
E] NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes 1P No [3 NA
❑ Excessive Ponding [] Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
U. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑'des JD No
❑ NA
❑ Yes No
❑ NA
❑ Yes N] No
❑ NA
❑ Yes 01 No
❑ NA
❑ Yes [M No ❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑ WUP []Checklists [:]Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. []Yes rM No
❑ Waste Application [3 Weekly Freeboard ❑ Waste Analysis [] Soil Analysis ❑ Waste Tr nsfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [ No
[DNA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Condnued

V
Fac ility Number: - Date of Inspection: a"Z o
/ 3
WastiMbllection & 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
Q9 NA
❑ NE
Structure 1 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
�0 No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
%] 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
0 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Ep 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 evid nce of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No
Tj
❑ NA
❑ NE
❑ Excessive Ponding Hydraulic Overload ❑Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
£Manure/Sludge
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
into
Bare Soil
Wind Drift �'] Application Outside of Approved
❑ Outside of Acceptable Crop Window ❑ Evidence of f-
Area
12. Crop Type(s); ; �SS rpc o "PJ
LJ 1i ' 1Lg
13. Soil Type(s):
-al<<15 U LA) n
14. Do the receiving crops differ from those designated in the CAWMP?
❑ es
fa No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Pa No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
K] No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[N No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists [—]Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA,
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stocking ❑Crop Yield ❑ 120 Minute Inspections ❑Monthly and 1" Rainfall Inspections ❑ Sludge Surveyti
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[P No
❑ NA
❑ NE ;
23, If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[P No
❑ NA
' ❑ NE
Page 2 of 3
21412011 Continued

Facility Number: q- / % Date of Inspection: % / 3
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. 1p
❑ 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 P No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
V9 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)
T
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
&] No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
C %
�Pc9tiG(s, 1�e v ,` et..-e-d
4 to
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: ft —Y .FT 3 ';t19
Date: 007 r% /,3
21412011

[Facility Number: - Date of Inspection:
24-. Difl 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:. '
if- 26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No
❑ NA ❑ NE
- Other Issues
.28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA '[:]'NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA ❑ NE
�J' • . ❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA ❑ NE
33. Did the Reviewerllnspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or anyaotber comments.
Use drawings,.of facility.to better explain' situations (use additional ageseas'necessary).,!'.­.,..,:
+:f Y
Reviewer/Inspector Name:
Reviewer/Inspector Signature: {/) Zel/(t!!.(Xy
Page 3 of 3
s. ,
Phone:
Dater o�
21412011

• Division of Water Quality
Facility Number ®- 0 Division of Soil and Water Conservation
0 Other Agency 11
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 0 Denied Access
Date of Visit: $ L Arrival Time: Q % Departure Time: County: B-w�PFA
Farm Name: �7 i 0 1 Owner Email:
Owner Name: I V l f AV!::!j— _ "-L Phone:
Mailing Address:
Region: FiQJD
Physical Address: Facility Contact: PA /� 1 l_i,tcu Title: Phone:
Onsite Representative: IA Integrator: 9 UA9L1r64VWP1 _.,_.—..
Certified Operator: D hyL ���i1 Certification Number: 23_57'7t7
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -La er
Design Current
Dry Poultry Capacity Pop.
Layers
Non -Layers
Pullets
Turkeys
Turkey Pouets
Other
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes MM No ❑ NA ❑ NE
❑ Yes ❑ No [�g NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes ❑ No
1� NA
❑ NE
c. What is the estimated volume that reached waters of the State.(gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes ❑ No
ERNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
ElYes No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

® Division of Water Quality
'jiicIIii y Number O Division of Soil and Water Conservation
Q Other Agency
Type of Visit: aCompliance Inspection O Operation Review p Structure Evaluation O Technical Assistance
Reason for Visit: (3) Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: -3 $ L Arrival Time: p S n Departure Time: 03;s m County: B� Region:HOT
r 11 `
Farm Name:Owner Email:
Owner Name: 4 U — &M O LLJC Phone:
Mailing Address:
Physical Address:
llFacility Contact: I Ct Title: Phone:
Onsite Representative: N Integrator: M UAJV ,. 001AM
Certified Operator: D Len C�-t/1 Certification Number: 2 %5*14
. Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity, Pop. Cattle Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
La er
Non -La er
Non-L
Pullets
Other
Poults
Design Current
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharses and Stream Impacts
I . Is any discharge observed from any, part of the operation?
❑ Yes
M No
[3NA
❑ NE
Discharge originated at: ❑,Srtructure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
® NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes'
❑ No
NA,
❑ NE
c. 'What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
ER NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[p No
i%
❑ NA
❑ NE
3. Were there any observable: adverse impacts or potential adverse impacts to the waters
❑ Yes
No
[:]'NA
❑ NE
of the State other than from a discharge?
Page I of 3 21417011 Continued

Facili Number: jDate of Inspection: Z
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2
Identifier:
Spillway?:
Structure 3 Structure 4 Structure 5
No ❑ NA ❑ NE
No NA ❑ NE
Structure 6
Designed Freeboard (in): 2
Observed Freeboard (in): 37
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) Lf
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 IM 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 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 Acceptablet�I_!C/rro-p Window n —❑ Evidence of WindDriftD• rift ❑ Application Outside of Approved Area,
12. Crop TYpe(s): aQCb'>f<t( "JA 61 qtc L J F�h�.G�Q 5 � . N(�A cr J' 400*-.�
t
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ya No
❑ NA
❑ NE
Reauired 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
No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
1� No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
r No
❑ NA ❑ NE
Page 2 of 3
21412011 Continued

Facilit Number: - Date of Inspection: 7..
WAsie Col ection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: _�—
Spillway?:
Designed Freeboard (in):
�� tl
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees,'severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
�No ❑NA []NE
❑No �NA ❑NE
Structure 6
❑ Yes
'R No
❑ NA
❑ NE
❑Yes
�No
❑NA
❑NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [g 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? T
Waste ARplication
10: Are there any required buffers, setbacks, or compliance alternatives that need ❑Yes 6 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
..p . ❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s)
U. Soil Type(s): e, )44nr.A
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
[P No
❑ NA'
❑ NE
lb. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
. ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
rR No
❑ NA
❑ NE
Required Records & Documents
1.9. 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
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23. If selected, did the facility fail, to install and maintain. rainb'reakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facility Number: jDate of Inspection: 3 IT
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 provide documentation of an actively certified operator in charge? ❑ Yes ❑ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
❑ No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
33. Did the Reviewerllnspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or,any other comments �; ,a,,
Use drawings of facility to better explain situations (use additional pages as necessary). �' a
qe S f-ev i a o j 3(' I{ z;
5(4 di'5+ �%f 6tIZ'
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: TO-0 -3LOO
Date: 318 .lz
21412011

Facility Number: 9-M Date of Inspection: 2-
20 Did li;� facility fail to calibrate waste application equipment as required by the permit?
I.
❑ 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.
w ❑ Failufe to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
' List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
❑ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes
❑ 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)
3l. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑ No ❑ NA ❑ NE
❑ Application Field. • ❑. Lagoon/Storage Pond ❑ Other:
• 32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[] No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No ❑ NA ❑ NE
' 34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ No ❑ NA ❑ NE
Comments (irefcr to question #): Explain any YES answers and/or any additional recommendations or 'any. other comments ...
Vse�'drawings of facility to better explaitusituations (use additional pages as necessa ).
5t4p- v S,4-- Vsh2.,
Reviewer/Inspector Name:.
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: 318fi
2/4/2Oil

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 ❑ Denied Access
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
%Arrival Time: M ILf��L�•-- Departure Time: cry County:
( — ✓`r]V Owner Email:
GOU)h
Facility Contact: Wilt Am"!5 Title:
H
Onsite Representative:
Certified Operator: �b h
Back-up Operator:��
Location of Farm:
Phone:
Region:
V
Phone No:
Integrator: W
Operator Certification Number:
Back-up Certification Number:
Latitude: [� o ❑ I =it Longitude: = ° Q ` =
il
Design Current
Population
Design Current Desi�H@Sinepacity
Wet Pulation
❑ Wean to Finish
❑ Laver
❑ DairyCow
❑ Wean to Feeder
❑ Non -Layer
❑ Dai Calf
❑ Dai Heifer
❑ Feeder to Finish
Farrow to Wean
z
Dry Poultry
❑ D Cow
❑ Non -Dairy
❑ Farrow to Feeder
❑ Layers
❑ Non -Layers
❑ Beef Stocker
❑ Farrow to Finish
❑ Gilts
❑ Beef Feeder
❑Beef Brood Cow
Number of Structures:
❑ Pullets
El Turkeys
❑ Turkey Points
❑ Other
❑ Boars
Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes P No ❑ NA ❑ NE
❑ Yes
❑ No
IR NA
❑ NE
❑ Yes
❑ No
99NA
❑ NE
❑ Yes
❑ No
P NA
❑ NE
❑ Yes
0 No
❑ NA
[:IN E
❑ Yes
IpNo
❑ NA
❑ NE
121,28104
Continued

r
Facility Number: tj— Date of Inspection s7
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
PNA
❑ NE
Strulure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): l r
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
JR 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
ILi 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
[ RNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes OPNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 'DNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable fC,ro,,Window ❑ Evidence of Wind Driift� Application utside of
Area
12. Crop type(s) G�rM �`�t. (k)1 �SCt.Q �I� �l 1 . 'kx I �'�
ba6wd
13, Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17, Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
rNo ❑ NA ❑ NE
�No ❑NA ❑NE
No ❑ NA ❑ NE
®No El NA El NE
R No ❑ NA ❑ NE
.Comments (refer to question ft Explain any YES; answers and/orany, recommendations or any other,,comments �'r`ti ","; t' ° l �
.Use drawings of facility to better explain situations. (use additional pages as'necessary):.. a;
Reviewer/inspector Name I Phone:
r10`31X7
Reviewer/inspector Signature: Date:
Page 2 of 3 12128104 ' Continued

1
w
Facility Number: Date of inspection S D
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ 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 V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Q No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
i9 No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
'No
❑ NA
ElNE
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
P 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
M No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
P No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
t No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

W Division of Water Quality
Facility Number O Division of Soil and Water Conservation
e) Other Agency
Type of Visit O Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit O Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival 'rime:: Departure Time: S� County: Region: Mo
Farm Name: ( r I �V i` I Owner Email:
Owner Name: rr✓N� �� L�L. Phone:
Mailing Address:
Physical Address:
Facility Contact: M'k0, '4yV' rlg O n Title:
I't
Onsite Representative: I /i
Certified Operator:
Back-up Operator: I V i l kP nVlpyl S
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
❑ Other
Latitude: 0
Phone
No:
Integrator: "lW �y�t'+� L(`
Operator Certification Number: a35'?0
Back-up Certification Number:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ Other
Discharyes & 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?
Longitude: = o = 1 = "
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dai Heifer
❑
Da Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Co
Number of Structures: Ell
I
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?
J
❑ Yes �&No ❑ NA ❑ NE
❑ Yes
❑ No
r%NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
[� NA
❑ NE
❑ Yes
1PNo
❑ NA
❑ NE
❑ Yes
15PNo
❑ NA
❑ NE
Page 1 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?
❑ Yes
P No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
qDNA
❑ NE
Stru ture 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: I
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 304
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
UIo
El NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
rr
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
E�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 FNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ 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
�5No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
�9 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
pA No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
P No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
'R No
❑ NA
❑ NE
Reviewer/Inspector Name 1 '" I Phone: 14P'—
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: TEUD
Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes (NNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes L'"J No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes M No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
J�j No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
jfS No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
P No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? []Yes , gNo ❑ NA ❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑Yes
tM AaW No
ElNA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
9 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
IM 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
JR No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
KNo
❑ NA
❑ NE
Add itionsh-Comments and/or _DraWingst
L
7
Page 3 of 3 12128104

Facility Number
ID Division of Water Quality 1 l I r
0 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 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other El Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: r i 0 Owner Email:
Owner Name: �-i�� of ` '*s �C 1.*.� i�i f� Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: _
Back-up Operator: _
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
❑ Other
Title: LM r tl Phone Nog L o % LOA
Integrator: --� !l
Operator Certification Number: 90
qms Back-up Certification Number: M1<37 9
Latitude: =' =' = " Longitude: = ° =1 = "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La y er
I❑ Non-Layet
Dry Poultry
❑ I.a ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Dischames & Stream Impacts
1. is any discharge observed from any part of the operation?
t
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cod
I
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: ID
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 N No ❑ NA ❑ NE
❑ Yes
❑ No
P NA
❑ NE
❑ Yes
❑ No
A NA
❑ NE
❑ No NA
❑ NE
❑ Yes
❑ Yes
PNo
❑ NA
❑ NE
❑ Yes
�eo
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection 0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): a
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 iM 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 PZNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes PONo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Wo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drill ❑ Application Outside of Area
12. Crop type(s)
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
PQ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
k No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application`?
❑ Yes
JVNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
kNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/inspector Name CSri N Phone.
Reviewer/Inspector Signature: Date:
12/28/04 Contindw

Facility Number: — j Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes t�No ❑ NA ❑ NE
20, Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [10E—Imlo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ 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? [:]Yes allo ❑ NA ❑ NE
23, If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No .&NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
o ElNA
❑ 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
0 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
9 NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�RNo
❑ 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
ElNE
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
MNo
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
12128104

Time In Time Out Date
Facility No. r ��
Farm N�
Owner
Operatc
Back-ur
COC MZ
Gir ra or
NPDES
Design
Current
Design
Current
Wean — Feed
Farrow —Feed
Wean — Finish
Farrow — Finish
Feed —
Gilts 1 Boars
arrow —WeanC1
Others
FREEBOARD: Design
Obse d
Crop Yield T
Rain Gauge
Soil Test
Weekly Freeboard
Spray/Freeboard Drop
Weather Codes
Waste Analysis:
Wettable Acres
Daily Rainfall
120 An lhtpections
Sludge Survey I✓ 3 +
Calibration/GPM°
Waste Transfers
Rain Breaker"
PLAT 4--
1-in Inspections
Date Nitrogen (N) Pete Nitrogen (N)
•Z- [ ,
1 V112t
Cal. ' � �� �r • . _ -�'�i■

Division of Water Quality ,$r1rp
Faciliff
ty Number l7 O Division of Soil and Water Conservation a 7
Other Agency
Type of Visit &fornpliance
Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
outine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: ►�
Farm Name: 72_% O Owner Email:
Owner Name: +� (�_ �A�S 6a2i;�5 17'7 C• Phone:
Mailing Address:
Physical Address:
Facility Contact: %kr, f fmm an i Title:
Onsite Representative:
Certified Operator:h"�--
Back-up Operator:
Location of Farm:
Swine
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
�o
Latitude:
Region: a
Phone No:
Integrator: ►'
Operator Certification Number:d357;;'D
Back-up Certification Number:
0 « Longitude: 0 ° ❑ ' =
Design Current design Current
Capacity .Population Wet Poultry Capacity Population
❑ Layer
^� ❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullcts
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current j
Cattle Capacity Population I
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dal
❑
Beef Stocket .
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures: D;
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes RNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

Facility Number: — 7 Date of Inspection ':2
' 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):L�
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 RNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes [Z No ❑ NA ❑ NE
❑ Yes RNo ❑ 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 [X No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 4 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 RNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes RNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 5jNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
�❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
PNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
ReviewerAnspector Name 'ev-e_ Phone:
Reviewer/Inspector Signature: Date: -
12/28/04 Continued

} Facility Number; — Date of Inspection •-D
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes XNo ElNA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ElYes 9 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 4No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
%No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
C4 No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�&No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
VNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
EgNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
�Z No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
RNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
C,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
C? No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
R No
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
K No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
t@ No
❑ NA
❑ NE
Additional Comments and/or D
12128104

2 YL f Z�2 xl2 -w !a
MH__1M
Type of Visit ® Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: /�Z ZZ— Arrival Time: Departure Time: Off' D County: �Region: /�20
Farm Name: _ _ 77/0_- Owner Email:
Owner Name: A/zI a pp Phone: d
Mailing Address: p 0. 8e>e 7� /&S e /fr`l` AfC.
Physical Address: 9W51• SL 12-
K!''l4
Facility Contact: „ Title: Phone No:
Onsite Representative: Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: E o= I= u Longitude: = o== u
Design Current
Design
Cu rent Design
Current
Swine Capacity Population
Wet Poultry Capacity
opulation Cattle Capacity
opulatian
❑ Wean to Finish I
IEJ Layer I I
013airy Cow
❑ Wean to Feeder
JEJ Non -Layer
❑ Dairy Calf
Feeder to Finish I
❑ Dairy Heifer
Farrow to Wean Z OD
1 9'00
Dry Poultry
❑ La ers
❑ Dry Cow
ElNon-Dairy
Farrow to Feeder
❑ Farrow to Finish
❑ N ers
Stocker
El El
ElBeef Feeder
❑ Gilts
❑ Boars
❑Pulets llets
❑ Beef Brood Ca
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
❑ Other
Number of Structures:
Discharses & 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 VNo ❑ NA ❑ NE
❑ Yes
[ONo
❑ NA
❑ NE
❑ Yes
JP No
❑ NA
❑ NE
❑ Yes
[A No
❑ NA
❑ NE
❑ Yes
P No
❑ NA
Cl NE
❑ Yes
0 No
❑ NA
❑ NE
Page 1 of 3 12128104 Condnued

Facility Number: Date of inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):/� r�
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
292No
❑ 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
5n No
❑ NA
❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[5 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 7No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs [:]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 h'Pe(s) SG�c-t . �Y� va /jfol
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Lr"t;VNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 21 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes [a 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 0 No ❑ NA ❑ NE
Comments refer to question # • Explain an YES answers•and/or any recommendations ar an other-toinm
Use drawings of facility to better explain situations. (use additional pagesas necessary) ;}° Y
Reviewer/inspector Name Phone:
Reviewer/Inspector Signature: Date:
/Z -_Z_L — Z a (�
Page z of 3 12128104 Continued

Facility Number: 1,79 — 171]Date of Inspection IZ-iZ-a
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [A No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes EP No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [4 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?
❑ Yes
P No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
EP No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
�E No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[�] No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
ONo
❑ 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
M No
[I NA
[I NE
Page 3 of 3 12128104

I
V' ivision of Water,
ater Quality'
Facility Number, % Division of Soil and Water Conservation
Other;Agency..
Type of Visit C�60mpliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral 0 Emergency O Other ❑ Denied Access
Date of Visit: �'`8�-0 Arrival Time: 0 1 Departure Time: ' DO County: 6 Region: PR o
Farm Name: 27 / _ _ Owner Email:
Owner Name: Ca r 1`0 �S ���3 7--'1 G - Phone:
Mailing Address:
Physical Address:
Facility Contact: CA r 1,S d 6n7 Title:
Onsite Representative:
Certified Operator:. i'�Js; .�K E:e
11
Back-up Operator:
Location of Farm:
Phone No: ,2-Z1"' _321- _
Integrator• I-q
4,1
Operator Certification Number: al 70 /
Back-up Certification Number:
Latitude: = o =' = " Longitude: = ° = ' ="
Design Current, Design, Current �i Design; "$ Current'
Swine Capacity. Population "Wet Poultry Capacity Population Cattle .,Capacity'4Poquiah on
10 Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean Ov 0
❑ Farrow to Feeder
❑ Farrow to Finish
Gilts
Boars
Other
❑ Other
❑ Layer I Dairy Cow
❑ Non -Layer I
EI❑ Dairy Calf
❑ Dairy Heifer
Dry Poultry ❑ Dry Cow
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ urkey Puults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
i Non-Dai
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
l----
Number of Structures 1 1 1:,
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes ER No ❑ NA ❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
Q� No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
XNo
❑ Yes
4 No
❑ NA
❑ NE
❑ Yes
®.No
❑ 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 $?jNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes �.No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): ,. r2Q
Observed Freeboard (in): .33
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes KA 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 JZ 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)
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 [KNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ 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
D& 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
0No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
RNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�&No
❑ NA
❑ NE
Comments (refer to question #): 'Explain any YES answers and/or any recommendations or anyk,other';comments.k '
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/inspector Name I -- - - -: `-s...
Phone:
Reviewer/Inspector Signature:
Date: i] 4.
Page 2 of 3 112128104 Continued

i
Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [TNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 9No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists []Design []Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes RNO ❑ 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 9No ❑ 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
Wo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
1% No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
9 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
J,No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
UNo
❑ 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
JR 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
�RNo
❑ 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
ERNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
OK No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit e-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: �fr Arrival Time: D Departure Time: I 9',"3D I County: _ Region: i o
Farm Name: 77 D Owner Email:
Nr"'OwnerName: Mote—D4 oocpWo' Phone:
Mailing Address:
Physical Address: n fir:. / 1,2 L
Facility Contact: `�✓1LJ�;e Title: Phone No:
Onsite Representative: T / Integrator:M/ l
Certified Operator: hle-'_64ZZ Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
Latitude: = 0= I❑ Longitude: 00
= 6 0 H
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
Z Farrow to Wean
Q
D
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑
Turkey Poults
❑
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures: lei
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
e. 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 CQNo ❑ NA ❑ NE
❑ Yes
[&No
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[& No
❑ Yes
L4No
❑ NA
❑ NE
❑ Yes
X No
❑ NA
❑ NE
12128104 Continued

J
f .
Facility N u mber-,0 Date of Inspection Gr .r
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
❑ Yes (" No ❑ NA El NE
❑ Yes rM No El NA ❑ NE
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
[21 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
N No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
rV 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
D4No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[?jNo
❑ 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 Drifl ❑ Application Outside of
Area
12. Crop type(s) 6 r4L c 6, a, e411 e5/cr
i
6-ry
13. Soil type(s) L ^
72k
/
L13 Q
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[qNo
❑ NA ❑ NE
15. Does the receiving crop and/or ]and application site need improvement?
❑ Yes
[4 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
[Q No
❑ NA ❑ NE
18. Is there a tack of properly operating waste application equipment?
❑ Yes
[Z No
❑ NA ❑ NE
jZd
Reviewer/Inspector Name �,: h '' Phone: y� /�/
Reviewer/Inspector Signature: Date: /D ry G —a,S`
12128104 Continued

Facility Number: Date of inspection O-
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ONo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes �No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists El Other
❑ Design [I Maps
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes QjNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
EZ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
'�" No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[0 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ZNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
C4 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
EfNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
5a No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
D9 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
54 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
[9 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
[K No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
12128104

(Type of Visit ® Compliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit ! Routine O Complaint O Follow up O Emergency [notification O Other ❑ Denied Access
Facility Number Date of Visit: 1 0 Time:
Q Not Operational Q Below Threshold
.Permitted VCertified 13 Conditionally Certified [3 Registered Date Last Operated or rAbove Threshold: - --•-..».».
FarmName: ......._ ....................................... __.........._ .. ....._ County: ».» ..» _.l�I.►......... »..».......» »..»».»......
OwnerName:....._._ + Q. �.... .»..a.__.__'_^ -..._ ... _ ...._.. Phone No:...».»..»..»......»..... _......._....._......._ ..»...».
Mailing Address:.._.. »._.4 1�_.. a .t. » ._. _._._.......» ._......».__._ _.. Qr Zkl ��.,F...._ L __.. _ .._... 2 YE
+
Facility Contact: ..., itT3"c...... 5Ajjl, _ _ __ Title:._ ....__._.._._.._ » ...__ _ . _ Phone Nor: f _._______________ _._.__
Onsite Representailve:.....�+�7{rS�P4:Cr.. »� ..i 1 �...._.................... Integrator:...
Certified Operator: , c•S lv�G », Operator Certification Number:,.... —._» ..............___—
Location of Farm: Ci
swine ❑ Poultry ❑ Cattle ❑ Horse Latitude a ' 66 Longitude ' ' «
Discharges & Stream Impacts,
1. Is any discharge observed from any part of the operation? ❑ Yes J� No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man -trade? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes MNO
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes RNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes Wo
Struc ure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Idendfier:
Freeboard (inches):
12112103 Continued

Facility Number: Date of Inspection
•
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes M No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes Jg� No
closure plan?
(If any of questions 4.6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
S. Does any part of the waste management system other than waste structures require maintenancefimprovement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes JZ No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ®,No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes MNo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copperand/or Zinc
12. Crop type F6&c_L v _ a ra,s v i. Q . &x-vv vJ-r,- - Q rm LeA . S PAA a rai A - a r'a > el.
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CA)WMP)? ❑ Yes ZLNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes XNo
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes KNo
❑ Yes KNo
❑ Yes E,No
❑ Yes ZNo
❑ Yes ❑ No
❑ Yes No
❑ Yes jffi No
❑ Yes V,No

Facility Number: Date of Inspection
Required Records & Documenu;
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
®,Yes
❑ No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
KNo
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes ANo
❑ Waste Applicatidw,"❑ FreeboagVn Waste AnalysV"O Soil Sampliwo,
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
4No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
MENo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
KNo
(ie/ discharge, freeboard problems, over application)
❑
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
2, No
28. Does facility require a follow-up visit by same agency?
❑ Yes
KNo
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
JLNo
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes KNo
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑,Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
jAdd. -.. _._ - •t l:S' t r f_ -„h vu _ - dot. ti t btEh r -
_.ttto.... .....�.�_._.. W,. n�$�L[.9i 4t st:� 4'F ..G'y��k
Zl. W S�F.er�vPr� D� ,nQ.t�►) �Q.�4.i'stt.r'w�rt� O'+1�51,�$.
re'co�LS
2 3 .. �� Acv►st�,at5 s 1 to�a'1f • 8 Cov (off K a+- . C i j c- rP o-V i•Ko s+'
.Z •p
VCCi
I2/12A3

Facilitti, Number Date of Visit: �� Time: Ir �a
10 Not O erational 0 Below Threshold
(� Permitted W Certified [3 Conditionally Certified 0 Registered pate Last Operated or Above Threshold:
Farm Name: �C-1 Vrc-n' 1� `S
�dr r-L 77 i b
County: iaa"A,
Owner Name: ar Y
Phone No: rt 1p _-213
—
Mailing Address:
Facility Contact: S 6La 4
S+ner_�-FaYw Title:
n
Vg12.Phone No:
OnsiteRepresentative: _ �a�+-G
—SI Kfi A ~ti
lntegratar:•-�al�'� 6Y1"i.r
�1�uw..)
Certified Operator: T' S 4 c-
5 ng < t 4- r
Operator Certification Number:
1 L, 3 67
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 6 " Longitude •
Design Current Design Current Design. Current
Swine Ca acftY Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder JE3 Laver I I ❑ Dairy
❑ Feeder to Finish ILI Non -Layer I I jr-1 Non -Dairy
Farrow to wean 7,400
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons I I _ I „',: ,"JU Subsurtac
Holding Ponds I Solid Traps " ` ❑ No Liquid
Dsscharees & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ LaEoon ❑ Sprav Field ❑ Other
a. if discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste ColleStion & Treatmeut
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): 3 TO
03103101
❑ Yes Qd No
❑ Yes ❑ No
❑ Yes ❑ No
N/A
❑ Yes ❑ No
❑ Yes DO No
❑ Yes I] No
❑ Yes [M No
Structure 6
Continued

Facility Number: — % f
Date of inspection
5. Are there any immediate threats to the integrity of any of the structures observed?.(ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Annlication
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes [ No
❑ Yes P No
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
[4 No
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
[23No
12.
CG rnzc} �4��
Crop type QCt „^�<�4s� •� r�r. �s pQ. �esci c . E��4 a ra s-s
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
[� No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
(] No
b) Does the facility need a wettable acre determination?
❑ Yes
[� No
c) This facility is pended for a wettable acre determination?
❑ Yes
[31 No
15.
Does the receiving crop need improvement?
❑ Yes
® No
16.
is there a lack of adequate waste application equipment?
❑ Yes
No
Regpired
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
(,g] No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
U No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
�{ No
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
[ No
24. Does facility require a follow-up visit by same agency?
❑ Yes
No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Cotnntents (refer to:quest€an 11) Explain any YES answers end/or'any recommendations or any other comments.
�Use'drawings of facility to better explatn3sitnstioas .(use additionalpages-as necessary):
Field Cory ❑ Final Notes
l
C l
j
Reviewer/Inspector Name
Reviewer/Inspector Signature;
Date:
05103101 Continued

"'X4 4,61visioh of Water Q4,allti-i:,
Oki•0
Mil Water Conservation
bivii1oh 'o'r
N,
0 Other Agency'
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit oRoutine OComplaint OFollow up 0 Emergency Notification 00ther (:] Denied Access
1 acility Number 171 Date of Xlkit: Time: �� --rl ro Not Operational 0 Below Threshold
E Permitted 13 Certified E Conditionally Certified [3 Registered , Date Last Operated or Above Threshold:
FarmName: 7.7.1.0 ....................................................................................... county: Dia4a ............... .. --------------------
Owner Name: Phone No:
MailingAddress: ............................................................................................ Ron-WHAC .......................................................... 7.8.45.h ..............
Facility Contact: Xs&ac.Sjngdtary .................................. Title: ............................................... Phone No: .......................................
Onsitc Representative: Integrator: C4.rrpjJ1S.F sjUX
Certified Operator: IN#Ac.B .................................. singilciacy ........................................ Operator Certification Number. 163.Q.7 ............................
Location of Farm:
ipprox. 2 miles east of SR 1100 atend efSR 1126
I& Swine [] Poultry [] Cattle E] Horse Latitude F 3-4 -10 34 6 52 6. Longitude 66
'-'Design Current Design Current Desig"n;'Current!
Swine Capacity Population-'_ P0uItrY ...-:Capacity. Population Cattle Capacity.. Population
El Wean to Feeder
El Feeder to Finish
Farrow to Wean
2400
El Farrow to Feeder
E] Farrow to Finish
,E] Gilts
JE1 Boars
Spray Field Area
IT Number ofLa oons
Subsurface Drains PresenLjUiFagoon Area
g
❑
Holding Ponds / Solid Traps'
-., I I , 1, 1[] No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: [] Lagoon [I Spray Field [I Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
I
d. Does discharge bypass a lagoon system? (Ifyes, notify DWQ)
[I Yes El No
D Yes El No
E-1 Yes D No
[:] Yes [] No
2. Is there evidence of past discharge from any part of the operation? [-I Yes [I No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? [3 Yes E] No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? [3 Spillway F-1 Yes 0 No
Structure I Structure 2 SIRICtUre 3 Structure 4 Structure 5 Structure 6
Identifier
Freeboard(inches.): ............ ..................... __ .................. ....... .......................... ........................... ..........................
05/03/0 1 Continued

Type of Visit fA Compliance inspection O Operation Review O Lagoon Evaluation
Reason for Visit 6 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit: i._W/01-T 1111ne: g : - Printed aw 5/30/2001
'7 Y
-»���.�.... �•......� 0 Not Operational Q Below Threshold
JdPermitted [3Certiified tIConditionallyCertifled 13 Registered Date Last Operated' or Above Threshold:.........................
FarmName: ►710.................................................................................................. County: 4 zw Fly
Owner Name:. ................... r �y
.....:.............. Phane Na:....,.: 1 c�`!.�.�.~31,/,,.%...
Mailing Address:
r.
Facility Contact:......x ....... 4'. le L............... 'I'itle:.........................
Onsite Representative:....7��...... s.i..f.?5tt luny ... ................ .................... I......
Certified Op crator: I
Location of Farm:
I
PhoneNo: ...................................................
Integrator:..........Ct1%5;
Operator Certification Number:. 4 t0 3d
i
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude . �• �{ ��� Longitude �• ��
Design Current Design -Current Design Current
Swine Capacity Population Poultry Capacity -'Pop Ovation. Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
❑ Feeder to Finish ❑ Nan -Layer 1E] Non -Dairy
Farrow to Wean o2 60
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design.Capacity.
❑ Gilts
❑ Boars TotaUSSLW
Number of Lagoons 10 Subsurface Drains Present 11EILagoon Area ❑ Spray FicW Area
Holding Ponds/ Solid.Traps; E= .. ❑ No Liquid Waste Management System
Discharger & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'?
b, If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gaL'tnin?
d. Does discharge bypass a lagoon system? (.If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4, Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Stnicture 3 Structure 4 Stnucture 5
❑ Yes (. -
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
rXNo
❑ Yes
W No
❑ Yes [ rNo
Structure 6
Identifier: ................. ......_...................................... ........................... ............................................ ................................................. I....................
Freeboard (inches):
05103101 Continued

Facil'r:y Number: Date oi' Inspection Printed on: 5/30/2001
it
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes [9No
seepage, etc.)
b. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes IV No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes PfNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes J'w No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes 0 No
Waste Anolication
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
No
11.
Is there evidence of over application? ❑ Excessive P1ondinyg ❑^PAN ❑ Hydraulic Overload
❑ Yes
No
12.
�.0
Crop type Re-6 L e ' w 0-�) , Fe_CKa1 gmt l CGra Semr1 Gf ;n
Cis_
13.
be the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
t�TNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
9 Yes
❑ No
15.
Is there a lack of adequate waste application equipment?
❑ Yes
IM No
_Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
1� No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes
No
(ie/ WUP, checklists, design, maps, etc.)
1%
19,
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
j No
20.
Is -facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21,
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
23,
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
O No
24,
Does facility require a follow-up visit by same agency?
❑ Yes
jNo
25,
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
[5rNo
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to question #} 'Explarn any,YES answer's.andiar anyjrecomnnendahons arYany ofher,co5mments
Use drawings of facility to better{explain situations , use additionahpages as necessary) '' -
- �, , n, ❑ Field Copy ❑ Final Notes
(5 — W o r1c on Luo_t� Can-tra { t�beu a i-+'�.%i5 . Fe5 euQ �' PS W
Reviewer/Inspector Name
ReviewerlInspector Signature: Date: IC Q
0510.3101 Continued

Facility Humber: Date of Inspection y / a.2 Printed on: 5/30/2001
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below [] Yes 19No
liquid level of lagoon or storage pond with no agitation?
27. Are there any. dead animals not disposed of properly within 24 hours? ❑ Yes $N0
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes M No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?.. ❑ Yes [YNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (Le. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes NFNo
32. Do the flush tanks lack a submerged fill pipe or a pennanent/temporary cover? ❑ Yes ❑ No
J
05103101

-
0 Division of Water Quality
QD1v1510i1 of`Saifand Watel ConSerVatian�a'�
Agency
i
Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ® Routine O Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
Facility Number �p 7� tfate of Visit: S %7 Q Time: = 20 Printed on: 7/21/2000
0 Not Operational 0 Below Threshold
Q Permitted ❑ Certified © Conditionally Certified [] Registered Date Last Operated or Above Threshold: ..............•
Farm Name: `'e4 ^�...0 22IO Count 1,�./�/c........................................
.............................. ...........I................ ..... .. Y .....
Owner Name e� Phone No•
'R ....................��r............................................. .. 9...... ... ...9... .Y.�Y...............
Facility Contact: ....... �j�r....rf?/..r ............'Title :....................... ..... . Phone No:...................................................
Mailing Address: .......... pi ..... /.....N.!Y...... ....+.bJ,.......fiV.!?'r ./.... ...C....... ... ............................. ..........................
Onsite Representative: ....... .......:+. v::- .. ... . Integrator:..... x7 s�.t......................................
Certified Operator:......, .r.... rt!„ fir........... J/^J ............. Operator Certification Number:..........................................
Location 'of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 6 it Longitude • 9 69
_..
r Design Current Design Current Design' Current
B '• ;, Poultry
CatteCa aci Population Capacity Population
Wean to Feeder ❑ Layer ❑ Dairy
ail: ❑ Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
"-1 Farrow to Wean
Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design ,Capacity �]
❑ Gilts
Boars Total S$LW
i r <;, 7 Ndiibi 10 Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
r t 'tip Heilding'Ponds /Solid Traps ❑ No Liquid Waste Management System
Discharees & Stream I_ muacts
1. Is any discharge observed from any part of the operation? ❑ Yes WNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes jRrNo
b. If discharge is observed, did it reach Water of the Stale'? (if yes, notify DWQ) ❑ Yes No
c. If discharge is observed. what is the estimated flaw in gal/min?
d, Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes gNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ;K No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge'? ❑ Yes 5fNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 07No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identirier:...... ....Q......y............................................. .........................................................................................
Freehoard (inches):
5100 Continued on back

i
Facility Number: Q Date of Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion, ❑ Yes PINo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes �INo
(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 VDNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? []Yes UNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ((
elevation markings? ❑ Yes [�No
Waste Application
10. Are there any buffers that need maintenance/improvement? [:]Yes XNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes A No
12. Crop type AgZ�A+
13. Do the receiving crops differ witfi those designated in the Certified Animal Waste Management Plan (CAWMP)? [:]Yes 2!rNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes A No
b) Does the facility need a wettable acre determination?
❑ Yes
29 No
c) This facility is pended for a wettable acre determination?
❑ Yes
X) No
15.
Does the receiving crop need improvement?
❑ Yes
%No
16,
Is there a lack of adequate waste application equipment?
❑ Yes
No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
j Yes
❑ No
18,
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ Wes, chests, design, map .)
❑Yes
,� No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
$f No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
A No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
discharge, freeboard
❑ Yes
XNo
(ie/ problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
❑ Yes
® No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
53 No
25,
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
E-J"No
iolglrio*'or. 0001 �enctes •ire �Qte�3 �1>rrfng �hjs:vXsit; Your wild reegiy160o; #'ufthor.
correspondence. abatit" this visit.
Comita'ents`(refer to', q' uestion #) Explain any YES answers and/or any recommendations or�aay other comments '
Use�drawuigs, bf faeffityito`betier explain/situations (use additional pages as necessary)
7.
�ls�t7 : Go id C c.r1 ti ojt �a,� -� tJ'�✓1'�i'��•..+i o� A.
•a• /c/1r�'� l.J/�`�' f�s�E'��d��.lsE l.J.e-fd�d��i.� y�s.•�D�.�c+�
Reviewerllnspector Name
Reviewer/Inspector Signature: Date: /% 5AV

Facility Number: p 9 — f7/
Date of Inspection S !7 D/ Printed on: 10/26/2000
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
P�No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
R No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
j NO
f
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
FNo
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
PNo
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
No
.,Additional Comments an or rawings: ,
AL
5100

Division of Water Quality
Division of Soil and Water Conservation
Q Other Agency
Type of Visit O Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Dale of Visit.- Time: .3r 3�Printed on: 7/21/2000
O Not Operational Q Below Threshold
*Permitted [3 Certified © Conditionally Certified © Registered Date Last Operated or lbove'l, "hold
Farm Name: ! ! County: �..��..L...�zz'.,............... ......................
......................................................................................................................... ........... .
Owner Name: .... .Gt.!'y'O..l..... Phone No:........1...,.?...'"./..•...........................
` ........................ /...
Facility Contact: ......-! ........... !L��k. /�/...'I'itle:..0 G;-► e ...../' .r................ Phone No:...................................................
s-� Q I �-`/ q P
Mailing Address: .....L.. �.....................................
f .�., f? .f�! .......................... at J ��:Q...t�t......
..... ..I.......�.
Onsite Representative:.,-,SS�t c............J..t.T q.l.:/'R-.'y......................... Integrator:............................�1..........................................
....
Certified Operator:...,Y.�. c{!✓'............................. c'. .�./. !`7....... Operator Certification Number:.........................................
Location of Farm: Location
.,
Iw
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' Longitude
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer 1 1 ❑ Dairy
❑,Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
Farrow to Wean 2
Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present 110 Lagoon Area JE3 Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at; [ILagoon ElSpray Field ❑ Other
a. li'discharge is observed, was the conveyance man-made''
h. If discharge is observed. aid it reach Water of the State'? (If yes, notify DWQ)
c. ll'discharge is observed. what is the estimated flow in gal/min?
d. Does discharge hypass a lagoon system'? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge'?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4
Identifier:.............................................................. ..... ............................................................................
Freeboard (inches): y"
�i
_31
s/oa
Structure 5
❑ Yes #`10
❑ Yes rNo
o
❑Yes
❑ Yes FNo
El Yes ' 1 No
❑ Yes KNo
❑ Yes i[so
Structure 6
Continued on back

i
Facility Number: — 1 7 Date of Inspection Printed on- 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed'? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan'? [:]Yes XCNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement'?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application'? ❑ Exc
12. Crop type BSC E
13. Do the receiving crops differ w' those design. tee
Ponding ❑ PAN ❑ Hydraulic Overload
in the Certified Ani
14. a) Does the facility lack adequate acreage for land application?
h) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination'?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
a
Waste Management Plan ((fAWMP)?
t
Required_ Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19, Does record keeping need improvement? Oe/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22.` Fail to notify regional DWQ of emergency situations as required by General Pert -nit'?
(ic/ discharge, freeboard prohlems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency'?
25, Were any additional problems noted which cause noncompliance of the Certified AWMP?
0; �o yiblati60s'ot- deficwnpies were hated. daring �his;visit; • Y;ojx ' iij - eeeiye 06 ruttboe • . • ; •
' Correspondence: a�atit this visit. ' ....... :................ .
9Yes ❑ No
❑ Yes 0—No
❑ Yes A No
❑ Yes P2�_No
❑ Yes 9No
❑ Yes
�No
❑ Yes
RNo
❑ Yes
�No
.EkNo
[]Yes
AYes
4W fo&—
❑ Yes
:! Jz
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
&d
❑ Yes �NO
❑ Yes ro
❑ Yes rNo
❑ Yes lNo
❑ Yes [:�rNo
❑ Yes No
❑ Yes No
❑ Yes ,�tvN.,00
El Yes 6 o
Reviewer/Inspector Name
ReviewerAnspector Signature: Date: `z� �i' 5/00

i
Facility Number: d — Date of Inspection -21 Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon Fail to discharge Ot/or hPlow ❑ Yes kNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 1*110
28, Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes JMNO
roads, building structure, and/or public property) ` \
29, Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes o
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes o
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes o
32, Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes 0+4e-
5100

V., ' 3 Division of Soil and Water Conservation , ,,Operation Review
Division of Soil and ' Aer Conse fr'vation, -Compliance Tnspechot `
l.� I
stun of Water QuaLty Compliance+Inspection , - , j
Other Agency -+Operation ReVlew ►;',, r
10 Routine 0 Comelaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review Q Other
� i no�ui ■ i m u■ uu n i i � um ii�iri uui�
Facility Number Date of Inspection
Time of Inspection 24 hr. (hh:mm)
Permitted Certified © Conditionally Certified 13 Registered 113 Not O erational Date Last Operated: .......
FarmName: ................. ►'I .............. ..1.l...................................I......................... County:............. &4141rm...an- ................
f/r/,�__ p
'Owner Name :.................. qr.U15....... -,('AC..-........... ............. Phone No:................../..�9..—9193.=35.4? . ............
55q.C......5; ... ..Title• ............ Phone No:
Facility Contact: ���� ..
Mailing Address: ............. C: P.'....... 6�P4.......... ................................. ...... ...................Al".a�y?q !1,........ .!�.. .........,.,.. ..... 3aAMC.(7
Onsitc Representative: ........... �SR C ........:......!...... �..... Integrator:.............F.&; .....
30
Certified Operator:................. ...... ..... ... D................................ ................... Operator Certiticatian Number:.......,.... ....".../.....,
Location of Farm.'SCt
............................................................'........................................................................................:...........................................................................................
........................................... .... ........................................ .... .. I ....... I .........................
Latitude �� 0` �•� Longitude
:, Design CUrrent '} �'�a' s� r ' f � `i DeSigT1 UTCent;; Design _ CllrCen .r'
Swine ,- Capacity Population ' 'Poultry Ca acit Po pulation Cattle Capacity Population ..
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean
El Farrow to Feeder
❑ Farrow to Finish
❑ Ulm
❑ Boars
W �Ho
❑ Layer ❑ Dairy
❑ Non-Layer�❑ Non -Dairy l
❑ Other
Total Design Capacity oZ 4100
Total SSLW
mber+of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
°Ponds /Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacls
1. I any discharge observed from any part of the operation? ❑ Yes WNo
4AVV" k61 Discharge originated at: []Lagoon ❑ Spray Field ❑ Other
f i a, If discharge is observed, was the conveyance man-made'? ❑ Yes [$No
a 4D
b, If discharge is observed, did it reach Water of the State'? ([f yes, notify DWQ) ❑ Yes( No
c. if discharge is observed, what is the estimated flow in gal/min'? 4
S d. Does discharge bypass a lagoon system? (If ycs, notify DWQ) ❑ Yes No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes j No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes [ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: l
Freeboard(inches): ..........��................................................... ,.............................................................................................................................................
.........
S. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes KNO
seepage, etc.)
3/23/99 Continuer) on hack

Facility Number: is — Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑Yes
� No
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
[ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
�] No
f
Waste Application
10, Are there any buffers that need maintenance/improvement?
❑ Yes
No
1 1. Is there evidence of over application? ❑ Excessive Ponding *PAN G'�(
es
❑ No
12. Crop type
���
S�1�t).
�
13. Do the receiving crops differ with those c esig aced in the Certified Animal Wasle M magern' Plan ( AWMP)?
❑Yes
[�No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
No
b) Does the facility need a wettable acre determination?
❑ Yes
( No
c) This facility is pended for a wettable acre determination?
❑ Yes
[� No
15. Does the receiving crop need improvement?
Yes
❑ No
16, Is there a lack of adequate waste application equipment?
❑ Yes
11No
_Required Records & Documents
17. Fail to have
ve Certificate of Coverage & General Permit readily available?
7 ❑ Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
�(No
,❑
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
[%No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
W No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
[XNo
23.
,Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
1XNo
24.
Does facility require a follow-up visit by same agency?
❑ Ye's
[;(No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
9No
``
�'Vfl'YiA1 tq>r s:or dil't�clera�ie� -W r� poted• dp-riog tMs•vjsjt;• ;Y;oiti ;With reptriye o; fjji�t�t�'
corresAondence. abbt f this visit. :.::::::.......:::::::::............ .
Commentsi(refer to -question #): Explain anyXES answers andlortany recommendations or any other comments.
g. facility , . .: (. a addition pages as necessary) ;, .
se drawtn s of faeth to.better exp am situat�o al
Aney
a. b ova
P4
K -U -�a
-c-
- "'Vv- pLoO � �
4 b1,
� S
�B@IT,.
Reviewer/Inspector Name �� fF Reviewer/Inspector Signature:
� ��,,,, Date: ( --/9q9
3/23/99

Facility Number: 0— Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes (� No
liquid level of lagoon or storage pond with no agitation? ,1
27. Are there any dead animals not disposed of properly within 24 hours`? ❑.Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property) ll��
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31, Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes W]No
Additional Comments 'and/or , rawiw:-
sa.
AJO
Ue- Loij L*,"O IJ CV /yk.
-(" pn"�,�� CV P"Vwd )VIV kwt�
e keld. at, 4vrv, c 4V 44 4aet,�v�,
GC
3/23/99

k 0 Division of Soil and Water Conservation 0 Other AgencyN
`0i�Division of Water Quality
0 Routine O Complaint O Follow-up of DW2 inspection O Follow-up of DSWC review G Other
Facility Number Date of Inspection
I i Time of Inspection /Z e� 24 hr. (hh:mm)
0 Registered ©Certified © Applied for Permit © Permitted JUNotOperational Date Last Operated: ..........................
FarmName:....................77140.................................................................................. County: ............. Il/.�(r fi�...............................................
OwnerName:...... Gr Ql..:l.. . r...........G..c................................. Phone No:..... 9�d ....�a�, .." i....................
Facility Contact: ............L:t74A::?..,$A_eV! .. Title:................................................................ Phone No:...................................................
Mailing Address: ............. ..... zp ..........7 W..a......... 1.20............................... ................
Onsite Representative:........................................................................................................... Integrator: .......4:, 0.eg0(l..'.,e-.';;a7 .sp ,
Certified Operator; ............ �r,f, w-C............. Operator Certification Number:......,1`„ p.7........
Location of Farm:
Latitude i it Longitude ' 0«
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
9No
2. Is any discharge observed from any part of the operation?
❑ Yes
No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
W-No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
® No
3. Is there evidence'of past discharge from any part of the operation?
❑ Yes
®'No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
VNo
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
)tNo
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
)Q"'No
7/25/97
Continued on back

w. . N
Facility number: p
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yeti X No
Structures (Lagoons',llolding Ponds, Flush Pits, etc,t
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes XNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(ft): .............�, /.. //............................................ .................................... ..... ...............................
10. is seepage observed from any of the structures'? ❑ Yes J9 No
11. Is erosion, or any other threats to the integrity of any of the structures observed'? ❑ Yes fK No
12. Do any of the structures need maintenance/improvement'? ❑ Yes ANo
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify D1VQ) '
i
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes No
Waste Application
14.
Is there physical evidence of over application?
Cl Yes
j No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ) _
15.
�
Crop type ...... Aw,,.4�J
T
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMIT
Yes
Q No
17.
Does the facility have a lack of adequate acreage for land application?
1.
❑ Yes
No
18.
Does the receiving crop need improvement?
f
iR•Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
04-No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
O No
21.
Did ReviewerAnspector fail to discuss review/inspection with on -site representative?
Cl Yes
15tNo
22.
t
Does record keeping need improvement?
❑ Yes
*No
For Certified or Pennitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
ArNo
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 further,
correspondence about this. visit.-
Comi66hts (refer'to questii6n4): Explain any.YES`answers and/or Any recommendations or any other comments, f
Use drawings.of facility to Netter explain situAtinns".'(use additional pages,as, necessary).'
IC .0140) DAA� ,v1U ��lUeW)-
7/25/97
Reviewer/Inspector Name, y
Reviewer/Inspector Signature: Date: 111r--/0

Routine Q Com taint O Follow-up of DWQ inspection O Follow-up of DSWC review 0 Other
Facility Number
Farm Status: ❑ Registered ❑ Applied for Permit
® Certified ❑ Permitted
Date of Inspection —5
Time of Inspection r oU 24 hr. (hh:mm)
Total Time (in fraction of hours
(ex:1.25 for 1 hr 15 min)) Spent on Review
❑ Not Operational Date Last Operated: ....... _........................
FarmName: .................7..�/.„..............................................
Land Owner Name:........i
FacilityConctact:..........: ^.-r!'_?: ...._ r�
q .(�?:..t`.�....�.. Title:
�...... ....�....�...
Mailing Address: ........... _..... .4..._���....`�tC� ...l ....
Onsite Representative . _. `� /...... �j�
................
_......
,
Certified Operator:.........'.17i.......................
_...........
.
Location of Farm: /
County: .............. .................
Phone No:._.L.F...10� 2 %3..,�/.3
... ................. Phone No: ...................... Z %� 6�
...............
� a ��z a
I
....... ..................
Integrator: ... o���r .,� G
Operator Certification Number:.,„..Ag.f¢,,,],,,.........
Latitude =* 0` =" Longitude 0* 0, ="
C„G, at
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
❑ Yes A No
[]Yes BNo
❑ Yes KIo
❑ Yes KNo
❑ Yes kNo
❑ Yes 'No
❑ Yes c po
❑ Yes i No
Continued on back

Facility Number:
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 1KNo
7:`Did the facility fail to have a certified operator in responsible charge? ❑ Yes WO
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes XNo
$trugitres (Lagoons A for 11pld102_andsl
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes ANO
Freeboard-(ft): Structure '� Structure 2 Structure 3 Structure 4 Structure 5
........: S ............................ ............................ ............................ ............................
Structure 6
............................
10. Is seepage observed from ',-"of the structures?
❑ Yes No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes XNo
12. Do any of the structures need maintenance/improvement?
XYes ❑ No
(If any of questions 9-12 was answered yes, and the situation poses an
Immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes kNo
Write Application
L 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 ..... e�'�I......P �rPz'e'C..................................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
XYes ❑ No
17. Does the facility have a lack of adequate acreage for. land application?
❑ Yes XNo
.18. Does the receiving crop need improvement?
Yes ❑ No
19. Is there a lack of available waste application equipment?
❑ Yes XNo
20. Does facility require a follow-up visit by same agency?
❑ Yes KNo
21, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes 9No
ForCertifigd Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes X No
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes )RNo
24. Does record keeping need improvement?
AYes ❑ No
oo
Vol
Reviewer/Inspector Name h°.< .. »TIONk„
llm
Reviewer/Inspector Signature: , Date:
cc. Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97