090181_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental QuA

A *-%
M Division of Water Resources
❑ Division of Soil and Water Conservation
❑ Other Agency
Facility Number.
090181 Facility Status:
ActiYe Permit: AWS090181
❑ Denied Access
Inpsection Type:
Compliance Inspection
Inactive Or Closed Date:
Reason for Visit:
Routine
County: Bladen Region:
Fayetteville
Date of visit
03f23l2017 Entry Time: 09:00 am
F_zlt Time: 9:30 am Incident #
Farm Name:
Farm 92
Owner Email:
Owner.
Murphy -Brown LLC
Phone:
910-296-1800
Mailing Address: PO Box 487 Warsaw NC 28398
Physical Address: Sr 1315 Red Oak Farm Rd Elizabethtown NC 28337
Facility Status: Compliant ❑ Not Compliant Integrator Murphy -Brown LLC
Location of Farm: Latitude: 34' 43' 00" Longitude: 78° 48' 07"
SR 1315 near Tarheel off of SR 1004 approx. 2 miles from Tar heel.
Question Areas:
Dischrge & Stream Impacts
Records and Documents
Waste Col, Star, & Treat
Other Issues
E Waste Application
Certified Operator: John S. Cain Operator Certification Number. 23570
Secondary OIC(s):
OnSke Representatire(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: AWS090181
Owner - Facility : Murphy -Brown LLC
Facility Number:
090181
Inspection Date: 03/23/17
Inpsecction Type: Compliance Inspection
Reason for Visit:
Routine
Regulated Operations
Design Capacity
Current promotions
Swine
Swine - Feeder to Finish
8,000
Total Design Capacity:
8,000
Total SSLW:
1,080,000
Waste Structures Observed
Disign
Freeboard
Type Idenffer Closed Date Start Data atad Freeboard
Freeboard
Lagoon
1
19.50
30.00
Lagoon
3092
20.40
page: 2

Permit: AWS090181 Owner - Facility: Murphy -Brown LLC Facility Number: 090181
Inspection Date: 03/23/17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Discharges & Stream Impacts
Yes No Na Ne
1. Is any discharge observed from any part of the operation?
❑
❑
❑
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
❑ 0
❑
b. Did discharge reach Waters of the State? (if yes, notify DWQ)
❑
❑ ■
❑
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑
❑ 0
❑
2. Is there evidence of a past discharge from any part of the operation?
❑
0 ❑
❑
3. Were there any observable adverse impacts or potential adverse impacts to Waters of the
❑
0 ❑
❑
State other than from a discharge?
Waste Collection. Storage & Treatment
Yes
No Na No
4. Is storage capacity less than adequate?
❑
■ ❑
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (Le./ large
❑
M ❑
❑
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not property addressed andlor 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
❑
M ❑
❑
maintenance or improvement?
Waste Application
Yes No Na No
10. Are there any required buffers, setbacks, or compliance altematives that need
❑ M ❑ ❑
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 > 100/6/10 lbs.?
❑
Total Phosphorus?
❑
Failure to incorporate manurelsludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
page: 3

Permit: AWS090181 Owner - Facility : Murphy -Brown LLC Facility Number. 090181
Inspection Date: 03/23/17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Waste Application
Yea No Na He
Crop Type 1
Crop Type 2
coastal Bermuda Grass
(Hay, Pasture)
Crop Type 3
small Grain Overseed
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Goldsboro sandy loam, 0 to
3% slopes
Soil Type 2
Norfolk loamy fine sand, 0
to 2% slopes
Soil Type 3
Wagram fine sand, 0 to 6%
slopes
Soil Type 4
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste
❑
■ ❑
❑
Management Plan(CAWMP)?
15. Does the receiving crop and/or land application site need improvement?
❑0
❑
❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
❑
0 ❑
❑
determination?
17. Does the facility lack adequate acreage for land application?
❑
❑
❑
18. Is there a lack of properly operating waste application equipment?
❑
❑
❑
Records and Documents
Yea No Na No
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑
0 ❑ ❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑
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?
❑
of -DO
If yes, check the appropriate box below.
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
❑
Weather code?
❑
page: 4

r r .
Permit: AWS090181 Owner - Facility: Murphy -Brown LLC Facility Number.
090181
Inspection Date: 03/23/17 Inpsection Type: Compliance Inspection Reason for Visit:
Routine
Records and Documents
yes No Na No
Rainfall?
❑
Stocking?
❑
Crop yields?
❑
120 Minute inspections?
❑
Monthly and V 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?
❑
Milo
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 ❑
❑
Otherlesues
Yea No Na Ne
28. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑
❑
❑
and report mortality rates that exceed normal rates?
29. At the time of the inspection did the facility pose an odor or air quality concern? If yes,
❑
E ❑
❑
contact a regional Air Quality representative immediately.
30, Did the facility fail to notify regional DWQ of emergency situations as required by Permit?
❑
E ❑
❑
(i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility?
❑
❑
❑
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 ❑
❑
CAWMP?
33. Did the Reviewertinspector fail to discuss reviewtinspection with on -site representative?
❑
M ❑
❑
34. Does the facility require a follow-up visit by same agency?
❑
0 ❑
❑
page: 5

Division of Water Resources
Division of Soil and Water Conservation
Other Agency
Facility Number. 090181 Facility Status: Active
permit: AWS090i81
Denied Access
Inpsection Type: Compliance Inspection
Inactive Or Closed Date:
Reason for visit: Routine County:
Bladen Region:
Fayetteville
Date of Visit: 07/28/2015 Entry Time: 12:00 pm Exit Time: 1:00 pm Incident #
Farm Name: Farm 92
Owner Email:
Owner: Murphy -Brown LLC
Phone:
910-296-1800
Mailing Address: PO Box 487
Warsaw NC 28398
Physical Address: Sr 1315 Red Oak Farm Rd
Elizabethtown NC 28337
Facility Status: Compliant Not Compliant Integrator.
Murphy -Brown LLC
Location of Farm: Latitude:
34' 4T 00" Longitude:
78' 48' 07"
SR 1315 near Tarheel off of SR 10D4 approx. 2 miles from Tar Heel.
Question Areas:
Dischrge & Stream Impacts Waste Col, Stor, & Treat
Waste Application
Records and Documents Other Issues
Certified Operator: John S Cain
Secondary OIC(s):
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:
Inspector Signature:
Secondary Inspector(s):
Inspection Summary:
Robert Marble
Phone:
Date:
page: 1

Permit: AWS090181
Owner - Facility : Murphy -Brown LLC
Facility Number:
090181
Inspection pate: 07/28/15
Inpsection Type: Compliance Inspection
Reason for Visit:
Routine
Regulated Operations
Design Capacity
Current promotions
Swine
Swine - Feeder to Finish
8,000
Total Design Capacity:
8,000
Total SSLW:
1.080,000
Waste Structures
Disignated Observed
Type identifier Closed Date Start Date Freeboard Freeboard
Lagoon
1
19.50
50.00
Lagoon
3092
20.40
page: 2

Permit: AWS090181 Owner- Facility : Murphy -Brown LLC Facility Number: 090181
Inspection Date: 07/28/15 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Discharges & Stream Impacts
Yes
No Na No
1. Is any discharge observed from any part of the operation?
❑
N ❑
❑
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)
❑
❑ ■
❑
2. Is there evidence of a past discharge from any part of the operation?
❑
0 ❑
❑
3. Were there any observable adverse impacts or potential adverse impacts to Waters of the
❑
M ❑
❑
State other than from a discharge?
Waste Collection, Storage & Treatment
Yes
No Na Ne
4. Is storage capacity less than adequate?
❑
M ❑
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (Le./ large
❑
0 ❑
❑ .
trees, severe erosion, seepage, etc.)?
5. Are there structures on -site that are not properly addressed and/or managed through a
❑
M ❑
❑
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
❑
M ❑
❑
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 Na Ne
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ 0 ❑ ❑
maintenance or improvement?
11. Is there evidence of incorrect application?
❑ 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: AWS090181 Owner - Facility : Murphy -Brown LLC Facility Number: 090181
Inspection Date: 07/28/15 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Waste Applicabon
Yes
No Na No
Crop Type 1
Coastal Bermuda Grass
(Hay, Pasture)
Crop Type 2
Small Grain Overseed
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Goldsboro
Soil Type 2
Norfolk
Soil Type 3
wagram
Soil Type 4
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste
❑
M ❑
❑
Management Plan(CAWMP)?
15. Does the receiving crop and/or land application site need improvement?
❑
■ ❑
[]
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
❑
■ ❑
❑
determination?
17. Does the facility lack adequate acreage for land application?
❑
0 ❑
❑
18. Is there a lack of properly operating waste application equipment?
❑
M ❑
❑
Records and Documents
Yes No Na No
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?
❑ 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?
❑ M ❑ ❑
If yes, check the appropriate box below.
Waste Application?
❑
Weekly Freeboard?]
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
❑
Weather code?
❑
Rainfall?
❑
Stocking?
❑
page: 4

Permit: AWS090181 Owner - Facility : Murphy -Brown LLC Facility Number: 090181
Inspection Date: 07/28/15 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents
Yes No No No
Crop yields? '
❑
120 Minute inspections?
❑
Monthly and V 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
❑
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:
2& Did the facility fail to provide documentation of an actively certified operator in charge?
❑
E ❑
❑
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
■ ❑
❑
Other Issues
Yes No Na No
28. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑
E ❑
❑
and report mortality rates that exceed normal rates?
29. At the time of the inspection did the facility pose an odor or air quality concern? If yes,
❑
0 ❑
❑
contact a regional Air Quality representative immediately.
30. Did the facility fail to notify regional DWQ of emergency situations as required by Permit?
❑
❑
❑
(i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility?
❑
E ❑
❑
If yes, check the appropriate box below.
Application Field
❑
Lagoon 1 Storage Pond
❑
Other
❑
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or
❑
E ❑
❑
CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑
❑
❑
34. Does the facility require a follow-up visit by same agency?
❑
0 ❑
❑
page: 5

Division of Water Resources
❑ Division of Soil and Water Conservation
❑ Other Agency
Facility Number. 090181 Facility Status: Attire
Permit: AWS090161
❑ 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: 12:00 pm Exit Time: 1:00 pm Incident #
Farm Name: Farm 92
Owner Email:
Owner: Murphy -Brown LLC
Phone:
910-295-1800
Mailing Address: PO Box 487
Warsaw NC 28398
Physical Address: Sr 1315 Red Oak Farm Rd
Elizabethtown NC 28337
Facility Status: Compliant ❑ Not Compliant Integrator:
Murphy -Brown LLC
Location of Farm: Latitude:
34' 437 00" Longitude:
78' 48' 07"
SR 1315 near Tarheel off of SR 1004 approx. 2 miles from Tar Heel.
Question Areas:
Dischrge & Stream Impacts Waste Col, Stor, & Treat
Waste Application
Records and Documents Other Issues
Certified Operator: John Samuel Cain Operator Certification Number: 987304
Secondary OIC(s):
On -Site Representative(s): Name Title Phone
24 hour contact name Mike Ammons Phone
On -site representative Mike Ammons Phone:
Primary Inspector: Robert Marble Phone:
Inspector Signature: Date:
Secondary Inspector(s):
Inspection Summary:
page: 1

Permit: AWS090181 Owner - Facility : Murphy -Brown LLC Facility Number: 090181
Inspection Date: 10/21/14 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations Design Capacity Current promotions
Swine
Swine - Feeder to Finish 8,000
Total Design Capacity: 8.000
Total SSLW: 1,080,000
Waste Structures Observed
Disignated
Type identifier Closed Date Start Date Freeboard Freeboard
Lagoon
1
19.50
46.D0
Lagoon
3092
20.40
page: 2

Permit: AWS090181 Owner - Facility : Murphy -Brown LLC Facility Number: 090181
Inspection Date: 10/21/14 lnpsection Type: Compliance Inspection Reason for Visit: Routine
Di5chaEges & Stream Impacts
Yes
No Na No
1. Is any discharge observed from any part of the operation?
❑
0 ❑
❑
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
[]
❑
b. Did discharge reach Waters of the State? (if yes, notify DWQ)
❑
❑
❑
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑
❑ 0
❑
2. Is there evidence of a past discharge from any part of the operation?
❑
M ❑
❑
3. Were there any observable adverse impacts or potential adverse impacts to Waters of the
❑
M ❑
❑
State other than from a discharge?
Waste Collection, Storage & Treatment
Yes No Na Ne
4. Is storage capacity less than adequate?
❑
0 ❑
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (Led large
❑
■ ❑
❑
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a
❑
M ❑
❑
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
❑
M ❑
❑
8. Do any of the structures lack adequate markers as required by the permit? (Not applicable
❑
M ❑
❑
to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑
M ❑
❑
maintenance or improvement?
Waste Application
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?
❑ 0 ❑ ❑
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
❑
PAN?
❑
Is PAN > 10%/10 lbs.?
❑
Total Phosphorus?
❑
Failure to incorporate manure/sludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
page: 3

Permit: AWS090181 Owner - Facility : Murphy -Brown LLC Facility Number: 090181
Inspection Date: 10/21/14 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Waste Application Yes No No Ne
Crop Type 1 Coastal Bermuda Grass
(Hey, Pasture)
Crop Type 2 Small Grain pverseed
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Goldsboro
Soil Type 2
Norfolk
Soil Type 3
Wagram
Soil Type 4
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste
❑
❑
❑
Management Plan(CAWMP)?
15. Does the receiving crop and/or land application site need improvement?
❑
❑
❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
❑
M ❑
❑
determination?
17. Does the facility lack adequate acreage for land application?
❑
M ❑
❑
18. Is there a lack of properly operating waste application equipment?
❑
■ ❑
❑
Records and Documents
Yes
No No 1q
.
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑
0 ❑
❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑
❑
❑
If yes, check the appropriate box below.
WUP?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Lease Agreements?
❑
Other?
❑
If Other, please specify
21. Does record keeping need improvement?
❑
M ❑
❑
If yes, check the appropriate box below.
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
❑
Weather code?
❑
Rainfall?
❑
Stocking?
❑
page: 4

Permit: AWS090181 Owner - Facility : Murphy -Brown LLC Facility Number: 090181
Inspection Date: 10/21/14 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents
Yos
No No Ne
Crop yields?
❑
120 Minute inspections?
❑
Monthly and 1" Rainfall Inspections
❑
Sludge Survey
❑
22. Did the facility fail to install and maintain a rain gauge?
❑
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?
❑
E ❑
❑
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?
❑
E ❑
❑
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
N ❑
❑
Oiler 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,
❑
N ❑
❑
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?
❑
N ❑
❑
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
❑
❑
❑
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

%
M
Division of Water Resources
❑
Division of Soil and Water Conservation
❑
Other Agency
Facility Number.
090181
Facility
Status: Active Permit:
AWS090181
❑ 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:
12:30 pm Exit Time: 1:00 pm
Incident #
Farm Name:
Farm 92
Owner Email:
Owner:
Murphy -Brown LLC
Phone:
910-296-1800
Mailing Address: PO Box 487 Warsaw NC 28398
Physical Address: Sr 1315 Red Oak Farm Rd Elizabethtown NC 28337
Facility Status: 0 Compliant ❑ Not Compliant Integrator. Murphy -Brown LLC
Location of Fans: Latitude: 34' 43' 00" Longitude: 78' 48' 07"
SR 1315 near Tarheel off of SR 1004 approx. 2 miles from Tar Heel.
Question Areas:
Dischrge & Stream Impacts Waste Col, Stor, 8 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 2J14/13
Site visit 2127113
page: 1

Permit: AWS090181 Owner - Facility : Murphy -Brown LLC Facility Number: 090181
Inspection Date: 02/27/13 Inssection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations Design Capacity Current promotions
Swine
Swine - Feeder to Finish 8,000
Total Design Capacity:
Total SSLW:
Waste Structures Observed
Disignated
Type Identifier Closed Date Start Date Freeboard Freeboard
Lagoon 1 19.50
Lagoon 3092 20.40
page: 2

Permit: AWS090181 Owner - Facility : Murphy -Brown LLC Facility Number: 090181
Inspection Date: 02/27/13 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Discharges & Stream Impacts
Yes No No 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?
❑
❑ ■
❑
b. Did discharge reach Waters of the State? (if yes, notify DWQ)
❑
❑ M
❑
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑
❑ 0
❑
2. Is there evidence of a past discharge from any part of the operation?
❑
0 ❑
❑
3. Were there any observable adverse impacts or potential adverse impacts to Waters of the
❑
0 ❑
❑
State other than from a discharge?
Waste Collection, Storage & Treatment
Yes
No Na No
4. Is storage capacity less than adequate?
1101111
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (I.e./ large
❑
M ❑
❑
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not property addressed and/or managed through a
❑
M ❑
❑
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
❑
0 ❑
❑
8. Do any of the structures lack adequate markers as required by the permit? (Not applicable
❑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
❑
M ❑
❑
maintenance or improvement?
Waste Application
Yes No Na No
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ M ❑ ❑
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%110 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: AWS090181 Owner - Facility : Murphy -Brown LLC Facility Number:
090181
Inspection Date: 02/27/13 Inssection Type: Compliance Inspection Reason for Visit:
Routine
Waste Application
Yes No Na No
Crop Type 1
Coastal Bermuda Gress
(Hay, Pasture)
Crop Type 2
Small Grain Overseed
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Norfolk
Soil Type 2
Goldsboro
Soil Type 3
Wagram
Soil Type 4
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste
❑ ■ ❑
❑
Management Plan(CAWMP)?
15. Does the receiving crop and/or land application site need improvement?
❑ M ❑
❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
❑ ■ ❑
❑
determination?
17. Does the facility lack adequate acreage for land application?
❑ 0 ❑
❑
18. Is there a lack of properly operating waste application equipment?
❑ M ❑
❑
Records and Documents
Yes No Na Ne
19, Did the facility fail to have Certificate of Coverage and Permit readily available?
❑
0 ❑
❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑
0 ❑
❑
It yes, check the appropriate box below.
WU P?
❑
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: AWS090181 Owner - Facility : Murphy -Brown LLC Facility Number: 090181
Inspection Date: 02/27/13 1npsection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents
Yes
No Na No
Crop yields?
❑
120 Minute inspections?
❑
Monthly and 1" Rainfall Inspections
❑
Sludge Survey
❑
22. Did the facility fail to install and maintain a rain gauge?
❑
E ❑
❑
23. If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment
❑
E ❑
❑
(NPDES only)?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
0 ❑
❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check the
❑
N ❑
❑
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?
❑
E ❑
❑
Other Issues
Yes No Na No
28. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑
❑
❑
and report mortality rates that exceed normal rates?
29. At the time of the inspection did the facility pose an odor or air quality concern? If yes,
❑
0 ❑
❑
contact a regional Air Quality representative immediately.
30. Did the facility fail to notify regional DWQ of emergency situations as required by Permit?
❑
E ❑
❑
(i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility?
❑0
❑
❑
If yes, check the appropriate box below.
Application Field
❑
Lagoon / Storage Pond
❑
Other
❑
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or
❑
0 ❑
❑
CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑
❑
❑
34. Does the facility require a follow-up visit by same agency?
❑
❑
❑
page: 5

1 ype of v isit: W uomptiance Inspection U Operation Review U Structure Evaluation U Technical Assistance I
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency Q Other O Denied Access -
Date of Visit: N I Arrival Time: w DepartureTime: County: 13 ypiRegion:
Farm Name: Cl'f.L�M �� Owner Email:"
Owner Name: AA y LLr � - PjYO(in LLr— Phone:
Mailing Address: ,
Physical Address:
Facility Contact: iY' K P17?'►M0ns Title: Phone:
r+
Onsite Representative:
Certified Operator: 3-Ok n LDa n
Back-up Operator: M t 4 AlllmotI5
Location of Farm:
Latitude:
Integrator: I(y� �ly- rA_0 W rn L Lc
Certification Number: o2 3 s%D
Certification Number: q OV90
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes R No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made'?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes
❑ No
[A NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
`V No
❑ NA
❑ NE
❑ Yes
yV No
❑ NA
❑ NE
Page I of 3 21412011 Continued

Facili umber: - 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 OPNA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier; I
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No
❑ Yes [� No
❑ NA ❑ NE
[] NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �] No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 01 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes P No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evid;nce of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): ! m 5M •
L*7vr-, UVf'fSQQA20
rR
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
W No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ 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
(5 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[jj 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
CR No
❑ NA [] NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Tfers
[] Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
Q§ No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
T
❑ NA ❑ NE
Page 2 of 3
21412011 Continued

FaciliNumber: - Date of Ins action:
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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the.inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes 0 No
❑ Yes M No
❑ NA ❑ NE
(DNA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes 0 No [] NA ❑ NE
❑ Yes P
No ❑ NA ❑ NE
❑ Yes A0
No
[:]Yes No
❑ Yes � No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Use drawlnlzs of facility tof h tier a plain situations (use additional.. palzes,as. necessarv). Y M cainments. J�omments (refer to uestion . Explain an YES answers and/or an additional recommendations or as ,ot
('s, �-- co,14C4j 5-11 /X
s Y-WI Viol"
ReviewerfInspector Name:
Reviewer/Inspector Signature;
—Vfrl& -MCLJA-
Page 3 of 3
Phone: i /0 -`t 33- 3 300
Date:
21412011

i yp�sm w uompuance inspection V uperateon xeview tV nrructure r,vaivanon V t ecnmcai Assistance
Reason for Visit: ® Routine O Complaint p Follow-up O Referral 0 Emergency O Other O Denied Access
Date of Visit: '�►"`'�►-Y` Arrival Time: Z ? Departure Time: County:[
Farm Name: '— �30 — 3 Owner Email:
Owner Name: C`rl u Rr7�nu► to w P1 , ti-- _ _ Phone:
Mailing Address:
Physical Address:
Region: EQ1
Facility Contact: (YN t Y-P— C." Title: Phone:
u
Onsite Representative: t Integrator: n u (LQ if 0 L N yn
Certified Operator: ]�,h,� i'(� Certification Number: D
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
Design Current
Design Current
Design Current
Swine Capacity Pop.
Wet Poultry C►►specify Pop.
Cattle
Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish D
DairyHeifer
Farrow to Wean
Design Current
Cow
Farrow to Feeder
D . P4oul Ca aci Pao
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
OtherI
10ther
Discharses and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [M 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)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No
❑ Yes EANo
❑ Yes 0 No
NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Type of Visit: (*Compliance Inspection V Operation Review V Structure Evaluation U Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
._ 3Date of Visit: Arrival Time: Departure Time: p }Od County: 6 we n Region:
Farm Name: `- 30 Q� — 3 Owner Email:
Owner Name: u Y7� lt,c� y n , L Phone:
' Mailing Address:
i
Physical Address:
Facility Contact: L—u ct C Title:
Onsite Representative:
Certified Operator: 0—Q t tN
Back-up Operator:
Location of Farm:
Latitude:
Phone:
'Integrator: iz +l a Lam)
Certification Number: 3ej�0 r
Certification Number:
Longitude:
Design Current
tDesign Current
Design Current
Swine Capacity Pop.
Wet Poultry Capac�ty� Pop.
Cattle Capacity MAOp.
Dairy Cow
Dairy Calf
Daia Heifer
Wean to Finish
Layer
Wean to Feeder
Non -Layer
Feeder to Finish 7M0
Farrow to Wean
g
esirrent
Dry Cow
Farrow to Feeder
D . P.oultky;:;Ca
La ers
naci Po P.
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Turkeys
Beef Brood Cow
101 QtherI
ITurkeyPoults
Other ImLi2ter
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?
❑ Yes Q No ❑ NA ❑ NE
❑ 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
❑i No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[] Yes
® No
❑ NA
❑ NE I
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

FacilitjNumber: Zj_ _ Date of Ins ection:
r
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[]Yes
gj No
❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
❑ No
Ej NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ilk
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
[:]Yes
d53No
❑ 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
CE]�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
R No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence
1of Wind Drift
❑ Application Outside o/ffApproved
,Area
12.CropType(s):iS���
13. Soil Type(s):
KN�
14. Do the receiving crops differ from those designated in the CAWMT ?
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?
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
2 No
❑ NA
❑ NE
❑ Yes
a No
❑ NA
❑ NE
[:]Yes
® No
❑ NA
❑ NE
❑ Yes [ja No ❑ NA ❑ NE
[:]Yes n No ❑ NA ❑ NE
❑ Yes 2 No ❑ NA ❑ NE
[]Yes Et No [DNA ❑ NE
❑ WUP ❑Checklists ❑ Design [] Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes Q No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [DStocking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes 8 No
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [�PNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: _ - 1 Date of Ins ection: oZ
/3
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
'10 NA
❑ NE
• Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 37 w
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
y@ 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
[�53No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑-Yes
[ o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® 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 0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need] Yes }c No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below.
❑ Yes ® No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc_)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence Wind" ❑ Application Outside of Approved
Area
, iof Drift
12. Crop Type(s): 1._7 e+� m c� 1�t1 ct-<-f . ["cz -c t e SM ,-
k 1 Ci f Q f o
-
We ifS e e C
13. Soil Type(s): 1 \C-A U I` - L—t U 66, W n qyQ ry\-,
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes 2 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes B 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 Q, No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes [ No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes ® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes ® No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Q No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
O Rainfall [:]Stocking 0 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 B No ❑ NA ❑ NE ;
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ZpNo ❑ NA ❑ NE
Page 2 of 3 21412011 Candnued

Facility Number: Ci- Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
RA No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
W No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
Vg No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
5� NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[0 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?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ® No ❑ NA ❑ NE
❑Yes ®No ❑NA ❑NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
® No
❑ NA
❑ NE
[—]Yes
No
❑ NA
❑ NE
❑ Yes
gg No
❑ NA
❑ NE
Comments (refer. to. question #): Explain any YES answers and/or arty additional recommendations or: any other comments: , I
Use drawings of facility to better explain situations{nse!additional pages as necessary). ':
e co R2- s
cj►A,-- Vi.S14-
Reviewer/Inspector Name:
ReviewerfInspector Signature:
Page 3 of 3
a j � -7/13-
14_ Phone: Q I 0 4 3 33 00
hADate:��
21412011

.e .,..., r .-,. - .,--, •Fr:-. . r -. n+-- •sS4 _ .. v-f
7
� - r�.� .r .. } -.. .r 3%r y._ n�_ _ _ �,r
.__ _ ,
.jFaciHtyNumber: 4 jDate of Inspection: a
7/
,.24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Z) No ❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
R 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
.ti
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
Eq No ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
r
❑ No ® NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [allo ❑ 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
F
ments(refer to question 9): Explain any YES answers and/or any additional recommendations or: any othercommentWE
—'rawings of facility to better explain situations (use additional pages as necessary): �m.� .;�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes ® No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA - ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Phone: Q I 0 4 33 33 DO
Date:
Z/4/2011

II ype of visit: W Compliance Inspection V Operation Review U Structure Evaluation V 'Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up - 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: $ j Z Arrival Time: Departure Time: b ;/ County: JE9ADF
AJ Region: 151QD
Farm Name: �` Owner Email: ;3
Owner Name: �% lyyp &-pow /}I { LC_ Phone:
Mailing Address:
Physical Address:
Facility Contact: M i kp Title: Phone:
ii J�,_
Onsite Representative: Integrator: Muir' Acwl•—
Certified Operator: n �.. Certification Number: 23SS10
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
Design Curren _� II Design burr nt
Design Current
Swine
Ca aci Po iWet°oult . Ca acio,: -
P ty pa f ry P h'
Cattle Ca aci Po
P ty P-
aP
Finish
La er
Da' Cow
Feeder
Non -La er
Da' Calf
o Finish
o Wean
rFarrow
t'�
Design Cqr er at
DairyHeifer
D Cow
o Feeder
_ D P,ouI . Ca aci 1-0
Non-Daio
Finish
La ers
Beef Stocker
Non -La ers
Beef Feeder
Pullets
Beef Brood Cow
Turke s
Other,_,
` Turkey Poults
Other
Other
Discharges and Stream Imnacts
1. Is any discharge observed from any part of the operation?
❑ Yes
V No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[:]No
[P NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
q§ 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

AYVV V[ v u«. V l..ULUPU3UCC luspCCuuu LJ "IMU MU L rV1t:W `f OtFUCLufC EVRILAUHUI1 LJ 1CCUUMCdI F►bbKJlallcC I
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: $ Z.. Arrival Time: t; pr1. Departure Time: p ;/ County: &ADISAI Region:
Farm Name: — Owner Email:
Owner Name: & Potv'i LLC_ Phone:
Mailing Address:
Physical Address:
Facility Contact. IVI I je,, Title: Phone:
Onsite Rep resentative: to Integrator: 1Y1 t^•
Certified Operator: ��hr., C .. Certification Number:
1. Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
III
Design
Current -�
Design
Current""", Design Current
fir`
Swine
Capacity
Pop Wet Poultry
Capacity
Popes Cattle ,_ Capacity Pop.
.. _ -
F..._...
La er
DairyCow
Non -La er
DairyCalf
^�a..
Dai Heifer
=`
Design
Currentr D Cow
:Dr , Poult :
Ca aci
Po Non -Dairy
La ers
Beef Stocker
Non -La ers
Beef Feeder
Pullets
Beef Brood Cow
Turkeys
Other
r" TurkeyPoults
Other
Other
Wean to Finish
Wean to Feeder
Feeder to Finish
Q
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
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)?
1
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
t
INNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/4/7011 Continued

Facility,Number: q - jyj= Date of inspection:
Waste Co118ction & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
T❑
❑ 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):yo
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
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
`P 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 Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[P
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes In No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window Evidence of Wind LLD ift�,❑ Application Outside of Approved Area
12. Crop Type(s): Cti T"' ✓, � 0",-
�
13. SoilType(s): NGr"IK, Wjn 7 , {VOffro ✓1'4
14. Do the receiving crops differ from those designated in theYAWMP?
❑ Yes
[W No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
0 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[] Yes
FO 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
Reguired 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
E] Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Cbecklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes `tom No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes N No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 09 No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

JF#dlity Number: q jDate of inspection:
Waste.Col%ction &Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
[3 NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
01 NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3�`•
�
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.)
a
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
QU 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
[P No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[P No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ® No' ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus [] Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑` Evidence of Wind Drift �,1 ❑ Application Outside of Approved Area
12. Crop Type(s): V`+ASS l['f '�"1 r " "�"`' OAg-7
13. Soil Type(s): ND r4,� 1K r LTlIn1 S h&-r' , WanYi7 v"
14. Do the receiving crops differ from those designated in the�eAWMP?
❑ Yes
® No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable]
Yes
® No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
© No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
i
[E] 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
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and. V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [] Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? E] Yes No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Ins ection:
24..Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes LrIV&& 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 0 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes ❑ No YDNA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
ONo ❑ 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
0
❑ NE
If yes, contact a regional Air Quality representative immediately,
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No ❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
T 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 oth&r comments.
Use drawings of facility to.better explain situations (use additional pages as necessary):=:
*0
„�.
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: J
2/ /2 11

l
Facili Number: - Date of Inspection: Mf2,,..
�24,Did th0facility 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
C76 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
i
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
[DNA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes *o
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No
0
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail'to notify the Regional Office of emergency situations as required by the
❑ Yes No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes j No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
T
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?
t
❑ 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,ftf.Explain any YES answers and/or any additional recommendations or anj other comments.'
Use;.drawings of facility -to better explain situations (use additional pages asmecessary}
a
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: _ f o
Date: 1
2/ /2011

IType of Visit *Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 4P Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: CJQi ttl County: Region:
Farm Name: 3naa 3 `- 1 Owner Email:
Owner Name: ► " t '`- GI c Phone:
Mailing Address:
Physical Address:
Facility Contact: A/ 1W1gPkA- qS Title: I Phone No:
u
Onsite Representative: Iutegrator: tQid�Til�
Certified Operator: h � Operator Certification Number: A�1 —
Back-up Operator /r�%.fT�"1� Back-up Certification Number: _
Location of Farm: Latitude: = o u Longitude: =] o E-1 , a N
Design Current Design Current Design Current
Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ La er I
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -La er I
❑ Dairy Calf
IQ Feeder to FinishEl
Wiry Heifer
'� �x
El Farrow to Weamultry-kX0111-
Dry
❑ D Cow
�❑ Farrow to Feeder❑
Non -Dairy
ers
❑ Farrow to Finish ❑
❑ Beef Stocker
Non -Layers
❑ Gilts ❑
❑ Beef Feeder
ts
❑ Boars ❑ pullets
El Brood Co
❑ Turkeys
Itne 10 Turkey Poults
❑ Other IF1 Other I
umber of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes T' No ❑ NA ❑ NE
❑ Yes
❑ No
P NA
❑ NE
❑ Yes
❑ No
[?TNA
❑ NE
❑ Yes
❑ No
P NA
❑ NE
❑Yes
'VNo
❑NA
❑NE
❑ Yes
l9 No
❑ NA
❑ NE
Page I of 3 12128104 Continued

- Facility Number: _1Z7T Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes l0 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
J0 NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes �No
❑ NA
El NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes bNo
❑ 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
maintenance/improvement?
❑ Yes No
I L Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes IP No
❑ 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 O Evidence of Wind Drift ❑ Application Outside of Area
❑ NA ❑ NE
❑ NA ❑ NE
12. Crop type(s) 111QS IVIJl-f0141 `
13. Soil type(s) p C C, 4
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ONo
❑ 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
N No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
gj No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations orAany other comments .
:Use drawings of facility to better explain-situabons.4use additional pages as necessar}}: '' t .
Ak
Reviewer/Inspector Name ( Phone:
Reviewer/Inspector Signature: Date: 5 !�
Page 2 of 3 12128104 Continued

11 Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 1� No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists El Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ERNo ❑ 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 6 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes D§ No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes F No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes IM 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
jn No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
F] No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
PNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
T
Page 3 of 3 12128104

J
Type of Visit *Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit • Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: 4jJOD County: NA'&Aoa Region:
Farm Name: _ Owner Email:
Owner Name: Mg Phone:
Mailing Address:
Physical Address:
c
Facility Contact: _—_ r " In `, �� Title: Phone No: QQ
Onsite Representative: Integrator: ' `J' b ''► �-�
Certified Operator: J �� "� � � Operator Certification Number: 9 351 V
Back-up Operator: Back-up Certification Number: 9
Location of Farm: Latitude: [= o =' = Longitude: = ° =' = u
Design @urrent; I. fMDesigrren Design CurreSwine Capaccity F.opulatioe# Poulpacity Population `Cattle Capacity Popula on
❑ Wean to Finish J 10 Layer N ❑ Dairy Cow
❑ Wean to Feeder i'❑ Non -Layer I ❑ Dairy Calf
Feeder to Finish `'F ❑ Dairy Heifer
Farrow to Wean Dry Paui#ry ❑ Dry Cow
[] Farrow to Feeder Y ` `A ❑ Non -Dairy
❑ El Layers
Farrow to Finish er
❑ Beef Stock
❑ Gilts ❑Non -Layers [] Beef Feeder
+ ❑ Pullets
❑ Boars � El Beef Brood Co
a ❑ Turkeys .
Other °�� ' " ❑ Turkey Poults
❑ Other Other `^Number of Structures:
Discharges & Stream impacts
Is any discharge observed from any part of the operation? ❑ Yes FINb ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
P NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
1PNA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
YINA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[�)Vo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
�110
❑ NA
El NE
other than from a discharge?
ll
Page I of 3
I2/28104
Continued

Facility Number: — g Date of Inspection / O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes E� No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No OfNA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3S
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes �XNo ❑ NA ElNE
(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 MVO ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes (`P o ❑ 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 h No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes Po ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn,
etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop 'ndow ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s) IM14
13. Soil type(s)
PC
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
M No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
OrNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
P No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
10 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ONo
❑ NA
❑ NE
Reviewer/Inspector Name Phone: i 1Y3 - 36D
Reviewer/inspector Signature: Date: 5
Pagel pf 1 1V-161U4 uonulluea

Facility Number: — Date of Inspection
Required 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 ElYes ibn
p No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design
g El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes *o ❑ 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 V No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 10 No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[PNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
[I NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
59 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
QRNo
1�P'
❑ NA
[I NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
{
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ONo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
$No
❑ NA
❑ NE
Additional'Commet is indtor Drawings: - ""' 'r
Page 3 of 3 12128104

Division of Water Quality t ��
Facility Number O O Division of Soil and Water Conservation
O Other Agency C'A
Type of Visit 16tCompliance 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: Arrival Time: Departure Time: County: Region
Farm Name: 1� o q 4?--- Owner Email:
Owner Name: LA LOL _ Phone:
Mailing Address:
Physical Address:
Facility Contact: 1 646 Title: Phone No:
Onsite Representative: + r l Integrator: 69—A, _
r r.
Certified Oneratnr: oi'�-�'t C� [lneratnr C'ertiliratinn Number -
Back -up Operator: v / / ! } ke ^_ Back-up Certification Number: qg!�
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
❑ Other
Latitude: E:] o E—] ' E—] Longitude: E] o E-1 , EJ "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
_ ❑ Layer
_ _'� ❑ Non -La et
Dry Poultry
Pullets
Poults
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: I T 1.
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 '410 No ❑ NA ❑ NE
❑ Yes
❑ No
It NA
❑ NE
❑ Yes
❑ No
t� NA
❑ NE
-
❑ Yes
❑ No
'Sb-4A
❑ NE
❑ Yes
&No
❑ NA
❑ NE
❑ Yes
NON o
❑ NA
❑ NE
12128104 Continued

Facility Number: —111Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes J%No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes RNo ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): . kp
Observed Freeboard (in): 7Zh
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
No
❑ NA ❑ NE
(ie/ Iarge 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
V No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes
� No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
,i 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
0,No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those desig7fated in the CAWMP?
❑ Yes
.t No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
10No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
PQNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
)Q No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
PQNo
❑ 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 `T N( Phone:
Reviewer/inspector Signature: Date: m t, p2(
Il%1S/U4 C.onttnueu

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists El Design ❑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
4No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
IMNA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
WNo
ElNA
ElNE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
Pq NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
4No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
t No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
!!
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
12128104

Facility No�w�4 19 ! Time In Time Out Date
Farm Name 41
Owner
Operator 6
Back-up
Integrator ,'
Pf
Site Rep _
No.
No.
COC ✓ C' ne r NPDES
r
Design
Current
Design
Current
Wean — Feed
Farrow — Feed
Wean — Finish
Farrow — Finish
ed — Eb§13
Gilts 1 Boars
crow — can
Others
FREEBOARD: Design
Observed
Crop Yield
Rain Gauge
Soil Test Wettable Acres
Weekly Freeboard � Daily Rainfall
Spray/Freeboard Drop
Weather Codes
120 min Inspections
Sludge Survey
Calibration/GPO -dd-ll 21, c,!
Waste Transfers-—�
Rain Breaker �y
PLAT - -
1-in Inspections
Waste Analysis:
Date Nitrogen (N) Date Nitrogen (N)
1
Pull/Field Soil Cro Pan Window

t�
ivision of Water Quality L�
Facility Number O Division of Soil and Water Conservation 3_��v7
Q Other Agency
Type of Visit QK-ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ( outine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ;3 Departure Time: i 3 County:
Farm Name: lh�Owner Email:
Owner Name: 0 r-D yj vt -5 oF Cara t; rta .k-rt e_ Phone: _
Mailing Address:
Physical Address:
Region: /C-xD
Facility Contact: AM- ken q,-In*li'1 jp,"— Title: Phone No:
Onsite Representative:. 510KL�_ _ _ __ Integrator:
Certified Operator: (_a—� 1'`' Operator Certification Number:,L7-5_i—/L2
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: E::] o E=] ' 0„ Longitude: E—] o =, = "
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish 91tD0 I FTOV
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -La er
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 ac ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes M No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes RNo ❑ NA ❑ NE
❑ Yes X No ❑ NA ❑ NE
12128104 Continued

I
Facility Number: — 1 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
V) 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): G�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
C9 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
[KNo
❑ 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
(N No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
D9 No
❑ NA
❑ NE
maintenance/improvement?
1 I . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes E[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) t/ ►s2�lGta rr
13. Soil type(s)
r
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
RNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
W 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?
18. is there a lack of properly operating waste application equipment?
❑ Yes R No ❑ NA ❑ NE
❑ Yes V[No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments. I
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date:
[�i�oivY l,U![[LI[uGu

i
Facility Number: — Date of Inspection —-D
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes O-No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes (9No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes SNo ❑ 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
[gNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
0 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
® No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
91 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
&No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAW MP?
❑ Yes
O No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
KNo
❑ 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
ZNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑Yes
�No
El NA
El NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
[RNo
❑ NA
❑ NE
Comments and/or Drawings:
12128104

Type of Visit ompliance 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: Z)I i i Arrival Time: Departure Time: ] County: Q&—kA Region: ►"�
Farm Name:QY -� Owner Email:
Owner Name: t1 S ��`� C7 �'►�� Phone:
Mailing Address:
Physical Address: / j� R
Facility Contact: M 6 n Title: LJJ KA Phone No 1 R)AQ l �0_
Onsite Representative: ' �c VLY t l OY1 S _ Integrator: f 1 b�y\
Certified Operator: �� _ �t � _ Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: r ---- 10 = 6 = Longitude: = 0 0 , 0 W
Design Current
Design Current . ° Design Current
entPopulation
Capacity Fopul
Layer ❑ DairyCow
EO Non -Layer ❑ DairyCalf
f> El Dairy Heifer
Manto Finish
❑ Wean to Feeder
eeder to Finish
❑ Farrow to Wean
D�Poult "
`" ❑ D Cow
❑ Farrow to Feeder
rY rY ^
�,� ❑Non-Dai
El Beef Stocker
❑ Feeder
❑ Farrow to Finish
❑ Gitts
er Beef
❑ Beef Brood Co
3r �
❑ Boars
Other
��IVurriber Structures:
❑
Other
of
❑+Lay Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Points
❑ Other
Discharges & Stream Impacts
L Is any discharge observed from any part of the operation?
❑ Yes
VMNo
❑ 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
*A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
'-�
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
A 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 adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
o
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: OT- Date of Inspection Oh
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?: q
Designed Freeboard (in): 1
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 'ERSo ❑ NA ❑ NE
❑ Yes ❑ No blA ❑ NE
Structure 5 Structure 6
El Yes �io ❑ NA ❑ NE
❑ Yes P 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 MNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ElNA ElNE
(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 ZPNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes IXNo ❑ 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 ❑ Evide�Jnce of Wind Drift ,,�❑f jApplication Outside off Area Q
12. Crop type(s) h 1")rl �Gi Yo-r-e C: r U ` ! G YQf Yl - `.t taizd,
13. Soil type(s) !�[ QY -Its I k- "� i J�>b d i O
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes �dNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes to
o El NA El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ YesNo El NA El NE
17. Does the facility lack adequate acreage for land application? ❑ Yeso ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑ NA ❑ NE
_comments (refer to question #): Explain any YES answers and/or any recommendations or auy other comments.
iUsesdrawings of facility to:better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name r! , �J C . N Phone: Y/O 4)013 3J
Reviewer/Inspector Signature: �_ Date: A vG � 4� 4 o
Page 2 of 3 12128104 Continued

Facility NBmber: — Date of Inspection I N 41C>6
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes )� No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 'FLNo ❑ NA ❑ NE
the appropriate box.
❑ W[JP ❑Checklists El Design El 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 04T o
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes Id No
❑ 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'1_9110
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Cl Yes PNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
o ❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
o ❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No ❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�'No El NA
El NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No ❑ NA
❑ NE
Additional Comments and/or Drawings:.
Page 3 of 3 12/28/04

Facility Not a Q ^ I l Time In Time Out Date
Farm Name .09� _ vz-(3Lyr q-L Integrator �A
Owner _ Site Rep �i�i„ Qi(h� i10Y1 1 C)
Operator
Back-up
COC �- Circle: General
€�
No.
or DES
Design
Current
Design
Current
Wean — Feed
Farrow — Feed
Wean — Finish
Farrow — Finish
Feed — Finish
00 U
Gilts 1 Boars
Farrow — Wean
Others
FREEBOARD: Design �2— Observed
Sludge Survey Calibration/GPM
Crop Yield Waste Transfers
Rain Gauge Rain Breaker
Soil Testf-Lo`S No PLAT Wettable Acres
\ ' Weekly Freeboard Daily Rainfall 1-in Inspections
v Spray/Freeboard Drop -4
Weather Codes
Waste Analysis:
Date
120 min Inspections
Nitrogen (N)
e12-1 1,
51 J k Z c�
q-] L4
I
Date Nitrogen (N)
2-li Z.'D
Pull/Field
Soil
Crop
Pan
Window
�-
r Cr
See aar
50
�
3
0I S 10 o
f0. 21ZZ
—
Sa
CLr

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: % 3fl Departure Time: + DQ County: 14A Of", Region: FkO
Farm Name: 1�'4t rryt L Z _ Owner Email:
Owner Name Gur►� 4 0� �sa.r�%w� .c . _ Phone:
Mailing Address: �a,t �. r_ax� {{ r IJL 28 Yea
Physical Address:
Facility Contact: Title:
Onsite Representative: \\ 'J ec
Certified Operator: Jam•S-
Back-up Operator:
Phone No:
Integrator: J~`Vr
11
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: E-1 0 0 ' = u Longitude: a o =, = "
Design Current
Swine Capacity Population
❑ Wean to Finish
❑ Wean to Feeder '
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts '
❑ Boars
Other.
❑ Other
Design Current
Wet Poultry Capacity Population
❑ Layer
❑ Non -La er
n Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
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?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Da Heifei
❑ Dry Cow
❑ Non -Dairy
—
Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: ELD
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 M;No ❑ NA ❑ NE
❑'Yes
❑ No
qNA
❑ NE
❑ Yes
[]No
[RNA
❑ NE
[RNA
❑ NE
❑ Yes
❑ No
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
7 No
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection 2b o
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes M-No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No k4 NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: =!`
Spillway?: tn1D
Designed Freeboard (in): �[Q• s
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 25 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 [SNo ❑ 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 D .No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ,,,�
9. Does any part of the waste management system other than the waste structures require El Yes 6No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers. setbacks, or compliance alternatives that need El Yes KNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 1•No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 Ibs ❑ Total Phosphorus []Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence ofWindDrift [I Application Outside of Area
12. Crop type(s) P.Tw�al —a(ma gj _ Swar.�l air t�i t?y�x3
13. Soil type(s)
v Zt8 Y$( "1
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
UKNo
❑ 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
PRVo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
J&No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[:]Yes
®.No
❑ NA
❑ NE
�' S • { I QJtiS4i � '-�l,Q� S v�,�1 ��w1 w 1 +� � �� ei d 5 N ec,� `� �trnrsc� Q.g
s1� as poss; b� .
Reviewer/Inspector Namex�y. R Phone �f
Reviewer/Inspector Signature: dA Date: dfTiro
12128104 Continued

Facility Number: — 18 f Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes D No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑Yes M1Vo ❑ NA ❑ NE
the appropirate box. ❑ WUII'� ❑ Checklists ❑ DesigW El Mape ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 9No []NA ❑ NE
❑ Waste Applicatio>1""❑ Weekly Freeboard' ❑ Waste Analyses❑ Soil Analysi+'❑ Waste Transfers ❑ Annual Certificatiori-'_
❑ RainfaV ❑ Stocking/❑ Crop Yiddo"'❑ 120 Minute Inspectior)k/❑ Monthly and V Rain InspectioW ❑ Weather Codd--*�'
22. Did the facility fail to install and maintain a rain gauge?
23, If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CA WM P?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30_ At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
[ No
❑ NA
❑ NE
❑ Yes
®.No
❑ NA
❑ NE
❑ Yes
gLNo
❑ NA
❑ NE
❑ Yes
gNo
❑ NA
❑ NE
❑ Yes
®.No
❑ NA
❑ NE
❑ Yes
Ed No
❑ NA
❑ NE
❑ Yes
PqNo
❑ NA
❑ NE
❑ Yes
9 No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
UKNo
❑ NA
❑ NE
❑ Yes
9 No
❑ NA
❑ NE
❑ Yes ;9 No ❑ NA ❑ NE
12128104

Type of Visit O Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ® Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: // G�/Cy 'Tune: : c D
Facility Number
-- O Not rational Q Below Threshold
® Permitted ® Certified © Conditionally Certified Q Registered Dat.Last Operated or Above Threshold:
Farm Name 4a 9� �/a �c,1 FipQ
county: ............__..._.........__........
Owner Name: /M r - %� c �y _ - 'Phone No: 9 0 2 f Sio 0
Mailing Address: Ao
Facility Contact: Title: — Phone No: _ ..
Onsite Representative: G rGg Cc z r Integrator. je-r o cON
Certified Operator: s& C g. i w r Operator Certification Number:70-
Location of Farm:
® Swine [If Poultry ❑ Cattle ❑ Horse Latitude • Du Longitude •
D S Stream b
1. Is any discharge observed from any part of the operation? ❑ Yes 1% No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a_ if discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) [3 Yes ❑ No
c. If discharge is observed, what is the estimated flow in galimin?
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 IX 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? ❑ Spey ❑ Yes No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
ld rifler
Freeboard (inches):
12/12/M3 Continued

Facility Number: 9 — Date of Inspection / d
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 [] Yes No
closure plan?
(If any of questions 4-6 was answered yes, and the situation, poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancerunprovement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes No
elevation markings?
Waste 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 No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Clop ype L7Elrriir.sl.. Qi.a �Lo�L / SY+� a l� o rQi
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes P No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes O No
b) Does the facility need a wettable acre determination? ❑ Yes M No
c) This facility is pended for a wettable acre determination? ❑ Yes [P No
15. Does the receiving crop need improvement? ❑ Yes 10 No
I6. Is there a lack of adequate waste application equipment? ❑ Yes Kj No
Odor Lssues
IT Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
19. Is there any evidence of wind drift during land application? (i_e. residue on neighboring vegetation, asphalt, ❑ Yes [% No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? if yes, contact a regional ❑ Yes [j3No
Air Quality representative immediately.

Faeili' Nnmber: Date of inspection
Reuuired Records & Docaments
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes 10 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 14 No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [,No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
(@ No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
9§No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑Yes
®No
(iel discharge, freeboard problems, over application)
(
27. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
28. Does facility require a follow-up visit by same agency?
❑ Yes
Q No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
[h No
NPDES Permitted Facilities
30. Is the facility covered under a NPDBS Permit? (If no, skip questions 31-35)
j] Yes
[I No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
gj No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
P 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
JE] No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
g] No
❑ Stocking Foam ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Type of Visit 0 Compliance inspection O Operation Review agoon Evaluation
Reason for Visit 0 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility- Number Date of Visit: Time: 3�
Not erational 13eloty Threshold
M Permitted © Certified O Conddi�tiona/lly Certified ©Reegistered Date Last Operated or Above Threshold:
Farm Name: 8To&)&5-/O i" C R y-D ;pici E41P "/ Count}•: _ 16 Al DAP ✓!
Owner Name: (/I- V 'e5nown ! Phone No: � Mailins Address: �0 �O .Y 7S 8 / ee1t/71
Facility Contact:
Onsite Representative:
Certified Operator:
Location of Farm:
Title:
Phone No:
Integrator:
Operator Certification Number:
Swine []Poultry ❑ Cattle ❑ Horse Latitude Longitude '
Deli Current = Des' n "Current = - Current
Sysinet.=. Ca achy :Po ulatioa `.,.PoutErr Ca achy Po vulation .;-Cattle__:' w Ca acaiv: 1?a ulatian
❑ Wean to Feeder_ r-
❑ La er ` ❑ Dai
® Feeder to Finish QO _ ❑Non -Laver = ❑Non -Dairy
❑ Farrow to Wean _
❑ Farrow to Feeder ❑ Other
(] Farrow to Finish _ Total DeSI C8 SCItF ~^
Gilts _ `p v XF
❑ Boars 1 = 0tsi-SSLW `-
- F=
Ilumber of Lagoons_t ❑ Subsurface Drains Present ❑ Lagoon Area 10 spray Feld Area
t
Holdmg Ponds/Solid Traps - r - ~ ❑ No Li uid Waste Management System v= a s_
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lasoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes. notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If ves, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection $ Treatment
4, is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: I
Freeboard (inches): 3J It
❑ Yes ❑ No
❑ Yes ❑ No
[:]Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 5
05103101 Continued

r
Facility Number: 199 — &I Date of Inspection
T
5. Are there any immediate threats to the integrity of any of the structures observed? i��e/'trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes ❑ No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenanceJunprovement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ❑ No
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement? ❑ Yes ❑ No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zmc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAVW)? ❑ 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 arse determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes ❑ No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge aVor below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑ No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ❑ No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes ❑ No
Air Quality representative immediately.
—
�Ca�ts re%r to ga�',�Expi� na3' �swers'andlor �9: ea -saw eo�tR:� r _" ---�
a0se disw a�e#yto beer ate. {slse ffi k ❑ Feld Copy ❑ Final Notes
•
- r
ReAevrwAbspedor Name
Reviewerihmpector Signature: Date:ZZf O Oe
earl-ru3 L.al+ur"S=

Type of Visit ® Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ® Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: O Time:
Facilit} Number .-
not O erational Below• Threshold
® Permitted ® Certified El Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm?Name: .Iti°+n 1Count-% L
Owner Name: � kz� Phone No: l O � ,Ll (u I gQ �
Mailins Address: _ Pj n . --,, 6 �� —�s�1�-ALL- !� ; �i $4
Facility Contact: Q . rl _�� 7--: ±L Title-,
Onsite Representative: V2. L� . !�•^� _.,,,_„_,_,
Certified Operator: s1,Vn .ram C
Location of Farm:
Phone No:
Integrator: %
Operator Certification Number: '-3 . 3-16 _
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' Longitude ' • OK
Design Current Design Current Design Current
Swine Ca acity Population Poultry Ca acitF Population Cattle Ca acity Population
❑ Wean to Feeder 10 Laver I ❑ Dairy
® Feeder to Finish ❑ Non -Laver I I Non-Dair>
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ soars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon :area 10 Spray Feld Area
Holding Ponds /Solid Traps ❑ No Liquid Waste Management System -
Discharges 8- Stream IM0201;
I. Is anv discharge observed from anv pan of the operation?
Discharge originated at: ❑ Laeoon ❑ 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 eal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection S- Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structin-e 3
❑ Yes [ANo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ® No
❑ Yes ®,No
❑ Yes EP No
Structure 6
Identifier.
Freeboard (inches): _ 3 3
05103101 Continued

Facility Number: — ( Date of Inspection T'�o
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes JANo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes q 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 (PNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes [2jNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes 5INo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes [ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes No
12.• Crop type
13. Do the receiving crops differ with those designated in the Certified Animal kaste Management Plan (CAWMP)? ❑ Yes C t 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
[NJ No
15.
Does the receiving crop need improvement?
❑ Yes
2j No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
No
Rtguired
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/ "P, checklists, design, maps, etc.)
❑ Yes
P 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
P,No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
® No
22,
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes] No
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative? ❑ Yes No
24. Does facility require a follow-up visit by same agency? ❑ Yes [Q,No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes 91 No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.

Facility Number: — fZ Date of Inspecihin
Odor- Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27_ Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt ❑ Yes No
roads, building structure, and/or public property)
29. is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes [ No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc_) ❑ Yes Rio
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes R No
32. Do the flush tanks lack a submerged fill pipe or a permanentitemporary cover? ❑ Yes ❑ No
05103101

-Division of Water uaEi
Q ty
O Division of Soil and Water, Conservation
$,. 0 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
Date of Visit: 4-]0-20pZ Time:
I j Facility Number 9 181
O Not O erational O Below Threshold
® Permitted ® Certified 0 Conditionally Certified © Registered Date Last Operated or Above Threshold: ........••....
Farm Name: Fairm.92................. ....... County: UlAde'll............................................... FRO.
Owner name:. .............................. ................. )Q.rn m's.of..Gar.�olirnat,.i�l�................... Phone No: 9X.Q-296:4�0Q.......................... ....
Mailing Address: 1'Q...P.x..7.51........................... ... . 1tvu.dill.A.C........................................................ 2#45.8 ..............
Facility Contact: AAX.c.Xo diu................................................... Title:.......................
Onsite Representative: R O,.ArAl.....................
Certified Operator- jobm,8........... ............. Calxt.'9 ...........-.... ..... ...........................
Location of Farm:
SR 1315 near Tarheel off of SR 1004 approx. 2 nines from Tar Heel.
Phone No:
Integrator:131 QKA.'.S.nf.CarQlimae.Ins.................................
Operator Certification Number: Z35.70....................
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 34 • 43 00 w Longitude 78 • 48 = 15
Design Current
Swine Canacitv Pnni latinn
❑ Wean to Feeder
N Feeder to Finish
8000
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle CapacitV Population
❑ Layer EE
Dairy
❑ Non -Layer Non -Dairy
❑ Other
Total Design Capacity 8,000
Total SSLW 1,080,000
Number of Lagoons L i ❑ Subsurface Drains Present ❑ Lagoon .area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
.,
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes N No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) El Yes ❑ No
c. I f 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 N No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge'? ❑ Yes N No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes N No
Structure 1 Structure 2 Structure 3 Structure 4 Stricture 5 Structure 6
[de ntif ier:...- .............................. .................
Freeboard (inches): 34
05103101
Continued

Facility Number: 9---181 Date of Inspection 4-10-2002
r
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type Coastal Bermuda (Graze) Coastal Bermuda (Hay) Matua
❑ Yes N No
[]Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes N No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Reouired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
8. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25_ Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes ® No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes ® No
❑ Yes N No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to question #): Explain.any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary): y❑ Field Copy ❑ Final Notes -
o problems observed.
Reviewer/Inspector Name Paul Sherman
Reviewer/Inspector Signature: Date: fD�Q
05103101 G Continued

Facility Number: 9-181 Date of Inspection 4-10-2002
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ® No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ® No
roads, building structure, and/or public property)
29. is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ® No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, mussing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ® No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ®No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional omments and/orDrawings:
r
O5103101

Fy �
Type of Visit ® Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ®Routine O Complaint. O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: !Z 6/ Time:
Facility Number
Q Not Operational Q Below Threshold
O Permitted 0 Certified 13 Conditionally Certified © Registered Date Last Operated or Above Threshold: --•W W--•
Farm Name: __.....-`�_....#.... ......................... County:.... Q..L�22p i ..
Owner Name: ... Vic✓.. �i��r........... Phone No:
Facility Contact: Title: ...................................... . ... .. . pPhone No: ------
Mailing Address:.... -.. a........f ....... �..! 'C J�..../!�...G,. �4 � •_ W. .
Onsite Representative: ............. !vl/ ...........I
----••----•-•-•-•--•--................... ................... Integrator: ......................... ---...........
_.................._....W.._-
CertifiedOperator: ............
..........................-----.........._...................---...-_....-.-....................... Operator Certification Number:
Location of Farm:
❑ Swine []Poultry ❑ Cattle []Horse Latitude • ` " Longitude • tau
"Desxgiii Current
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
-. . • : Design - Cnrreat Design = _ Cuii
Ponl
_.....
. a at ;CPo
❑Layer t
FE]
Dairy
❑ Non -Layer Non -Dairy
❑ Other
Total Design CaPacitY :
- -Total SSLV1►
.. 4 Nfzx ber d Lagoons Subsurface Drains Present Lagoon Area ❑ Spray Field Area
Holding Pond§ !Solid Tra>
,. .- ps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
IN No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
NNo
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
❑ Yes
IN No
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
❑ Yes
® No
2. Is there evidence of past discharge from any part of the operation?
❑ Yes
& No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
Jallo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes A No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: ..........................
Freeboard (inches):
5100
Continued on back

s ,..
Facility Number: &? — /8/ f Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 4NO
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes JELNo
(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 maintenancefimprovement? . ❑ Yes Jallo
9. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes BNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes IRNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes WNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes CR:No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 19No
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)'Ibis facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
Wo
16. Is there a lack of adequate waste application equipment?
❑ Yes
Wo
Required Records & Documents
17, Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
UNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes
Wlo
(ie/ WUP,checklist, desigt}rmaps, etc.) r
19. Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
�P10
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
ANo
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
9No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
eANo
(iel discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss mview/inspection with on -site representative?
❑ Yes
M No
24. Does facility require a follow-up visit by same agency?
❑ Yes
-bithTo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
KNo
? Y�l li gs:ei- d f c�eA�i vv re pQf�i• � g �.. •Yoh w�] lree . .too . ' • - -
.... . .. .
'
cories deia& aNv f this visit'
,ems Ili
Reviewer/Ins
pector Name
_ -- -
Reviewer/Inspector Signature:.. �,;� Date:5100

Facility Number: 09 -- % 4 Date of Inspection D/
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor 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 E$No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ®.No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes [Rio
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 R-No
M. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes Wo
32, Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ® No
5/00

A
Division of Water
Division of Soil and -Water
to
-Water Conservation
Q-Other. Agency
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit qkRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of visit: — —4-11.3Tune:: C Prinied on: 7/21/2000
Q Not Operational Q Below Threshold
Permitted [3 Certified M Conditionally Certified 13 Registered Date Last Operated or Above Threshold: ................
Farm Name:..._.....r!w19.5...............�................................................................ County.
gib - .....................
OwnerName: Phone No d 2S —.............................. ............................................................................................ r..................... .
Facility Contact: ........�4.n1 fS.................... Title: Phone No: ..
Mailing Address: P.... .-.L1�1 ..../..........................................................................to
.1Q l 3�..Lt1(.L� ....................... Z 3�i g
OnsiteRepresentative: ....JJ....................................................................................................... Integrator:.............................................
Certified Operator.,-„„I,P n rt ............. .................. . Operator Certification Number:
Location of Farm:
I�
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• C�` � �� Longitude �• �° �'
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Pol2alation
❑ Wean to Feeder 10 Layer ❑ Dairy
Feeder to Finish JE1 Non -Layer ❑ Non -Dairy
Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons I0 Subsurface Drains Present ❑ Lag^-n Area ID Spray Field Area
Holding Ponds / Solid Traps 10 No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: []Lagoon ❑ Spray Field [:]Other
a- If discharge is observed, was the conveyance man-made?
b. If discharge is observed. did it reach Water of the State'? (if yes, notify DWQ)
c. If discharge is observed. what is the estimated ]low in gal/min'?
d- Does discharge bypass a lagoon system? (if yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4- Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure t Structure 2 Structure 3 Structure 4 Structure 5
Identifier: .................................................................................................................
Freeboard (inches):
3z
5100
❑ Yes UVIa
❑ Yes '�No
ElYes 9Vo
❑ Yes �No
❑ Yes t2,No
❑ Yes JR(No
❑ Yes KNo
Structure 6
Continued on back

Facility Number: Date of Inspection ® Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, 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 main ten ance/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? ❑ Excessivel Ponding l ❑ Hydraulic Overload
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ic/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
tia ... defcien. .. v..notes during tt:v.. ... . . . . e. & ..Rio f.. Cher,
corres�6riciene . about this :visit.:::: . ... .
❑ Yes No
❑ Yes No
❑ Yes KNo
❑ Yes No
❑ Yes lNo
ifs o
RYes ❑ No
❑ Yes X-No
❑ Yes No
❑ Yes F jNo
❑ Yes Of No
❑ Yes E'No
❑ Yes ffNo
❑ Yes 1�No
❑ Yes qNo
❑ Yes �No
❑ Yes ONO
Comments (refer to question #f): 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):
it//. See + I y�
�$. M,9re / sG+xc C r449-' /hares 4i 1 C—ol C.r"yr":5'S Jh Ae
d r i e ta] o -� �'K �c tr . &J,- T sje a`( J r: j e" .
%solo- yt,,od• ( ,k, on 0- e/�i� I
S.3 n /• 3 t 2.0 c+,s Ra osier p p r� c� yak �k�S acca�►t+4
�i
Reviewer/Inspector Name ~~
Reviewer/Inspector Signature: Date: 5/00

Facility Number: m Date of InspectionL—UJ Punted on: 7/21/2000
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 A� No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes o
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 RNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ZO
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yeso
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? dYes ❑ No
5100

(,=
Revised April 20, 1999
JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facility Number U 1-19L peration is flagged for a wettable
Farm Name: f1a,- 0 TX _ acre determination due to failure of
On -Site Representative: alerts t[yi S Part H eligibility item(s) F1 F2 F3 ( 4,
InspectodReviewer's Name: -if�� Bra Operation not required to secure WA
determination at this time based on
Date of site visit: V/—917 exemption E7 E2 E3. E4
Date of most recent WUP: 131-- I6
Annual farm PAN deficit 9F19 pounds
Operation pended for wettable acre
'determination based on P9 P2 P3
x.
Irrigation System(s) - circle #.0ard-hose traveler, 2. center -pivot system; 3. linear -move system;
4. stationary sprinkler system w/permanent pipe; 5. stationary sprinkler system w/poriable pipe;,
fi. stationary gun system w/permanent pipe; 7. stationary gun system wlportable pipe
PART 1. WA Determination Exemptions (Eligibility failure, Part II, overrides Part I exemption.)
E1 Adequate irrigation design, including map depicting wettable acresjs complete -
and signed by an I or PE.
E2 Adequate D, and D2/D3 irrigation operating parameter sheets, including map
depicting wettable acres, is complete and signed by an I or PE.
E3 Adequate D, irrigation operating parameter sheet, including map depicting
wettable acres, is complete and signed by a WUP.
E4 75% rule exemption as verified in Part III. (NOTE: 75 % exemption cannot be
applied to farms that fail the eligibility checklist in Part II. Complete eligibility
checklist, Part II - F1 F2 F3, before completing computational table in Part III).
PART H. 75% Rule Eligibility Checklist and Documentation of WA Determination
Requirements. WA Determination required because operation fails one of the eligibility
requirements listed below:
F1 Lack of acreage which -resulted in over application of wastewater (PAN) on -spray
field(s) according to farm's last two years -of irrigation -records:
F2 Unclear, illegible, or lack of information/map.
F3 Obvious field limitations.(numerous.ditches; failure to deduct required _:. .
buffer/setback acreage;-or_25% of total acreage identified in CAWMP includes::
small, irregularly shaped fields = fields less than 5 acres -for travelers -or less than
�2 acres for stationary sprinklers).
F4 WA determination required because CAWMP credits field(s)'s acreage in excess
of 75% of the respective .field's total acreage as noted in table in Part 111.

Revised April 20, 1999
Facility Number
Part ill. rleia Dy rieia uezerminauon
oT
107o Exemption mule Tor rrvA veierminauon
TRACT
NUMBER
FIELD
NUMBER'-2
TYPE OF
IRRIGATION
SYSTEM
TOTAL
ACRES
CAWMP
ACRES
FIELD
%
COMMENTS'
lq
10
C .. .
ass
1 q 9S
3
C,
l49 2
3
Cal?
11490
1490f
b
4. 5
1 �
3, -7 F
3•
FIELD NUMBER'
- hvdrant. Dull. zone_ or ooint numbers may
be used in place of field numbers denendina on CAWMP
and type of irrigation system. If pulls, etc. cross more than one field, inspectorlreviewer will have to combine fields to
calculate 75% field by field determination for exemption; otherwise operation will be subject to WA determination.
FIELD NUMBER' - must be clearly delineated on map.
COMMENTS' - back-up fields with CAWMP acreage exceeding 75% of its total acres and having received less _than 50%
of its annual PAN as documented in the farm's previous two years' (1997 & 1998) of irrigation records, -cannot serve as the
sole basis for requiring a WA Determination. Back-upfields-must:be noted in -the comment section and must be accessible
by irrigation system.
Part IV. Pending WA Determinations
P t Plan lacks following .information:
P2 Plan revision -may satisfy75% rule based.on adequate -overall PAN deficit and by
adjusting all field acreage to -below 75% use -rate
P3 Other (iern process of installing new irrigation system):

4
0 Division of Soiland.Water._Conservation =Operation] eview'' .
0 Division of Soil ands Water Conservation - Compliance Inspection
0 Division Agency.
of Water;Quality - Compliance Inspection
0 Other -Operation Review
LO Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review ti Other
Facilitv Number 09 1$1 Date of Inspection 2-22-2000
Time of Inspection 1:25 24 hr. (hh:mm)
® Permitted ® Certified 13 Conditionally Certified 13 Registered [3 Not O erational Date Last Operated:
Farm Name: >Faxm.2.2............................. --- County:BlAdell.................................... ........... fRO.---------..
Owner Name: ................................................... Br.Q.n''a.ctf.Carolixta.,.Inc................... Phone No: 91.4-Z lrr 18AQ...........................................................
Facility Contact: ...........
Title:
PhoneNo: ...................................................
Mailing Address: J!.Q?.U.Q 48.2............................................................................................ Wa1Cxaw.1YC.............................. . Z Q8..............
...........................
Onsite Representative: ........................................................................................................... Integrator: Hrwwja'A.91'.Cax Qlina. C ................................
Certified Operator:,Gjcaw9.Qd,L........................ Vjtyjj ................................................. Operator Certification Number:163.6,1 .............................
Location of Farm:
Latitude 34 ' 43 00 u Longitude 78 • 48 G 15
Design Current
Design Current
Design Current
Swine Capacity Population
Poultry
Capacity Population Cattle
Capacity Population
_
❑ Wean to Feeder
I
❑ Layer I
I
Dairy
® Feeder to Finish
8000
ILI Non -Layer I
I E]FEI
IE)Non-Dairyl
Farrow to Wean
El Farrow to Feeder
❑ Other
Lj Farrow to Finish
Total Design Capacity
8,000
is
Total SSLW
1,080,000
Ll Boars
Number of Lagoons 10 Subsurface Drains Present ❑Lagoon Area JE1 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? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure G
Identifier: ...................................
Freeboard (inches): 20..
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
3/23/99 Continued on back
Printed on 3/7/2000

Facility Number: 09-181 Date of Inspection 2-22-2000
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
❑ No
Waste APRlication
10. Are there any buffers that need maintenance/improvement?
❑ Yes
❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ 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
Nd-viblati6ris:or deficiencies-were'nbted:duriilg this visit.:You:will'receive no ftirtlie'r
: ctirresporidence"abou>this:visit:.::-.: ..: : ::. ...:-:::: - :-:::•::•::•:'
( q #)•. xplain:an YES answers and/or any recommendations.or,any other comments..
Use drawings of facility fo better Y y
Comments (refer to question
y eiplaih situations.�(use additional pages as necessary):
;ite visit was made to check the level of the lagoon. Lagoon contained the required freeboard. Did not speak to an on -site
representative.
Reviewer/Inspector Name Jeffery Brown
Reviewer/Inspector Signature: Date:
9V
on 31712000

v'
/ 13 Division of Soil and Water Conservation = O erafton Review
�. ., P - f
..Division of Soil and Water Conservation -Compliance Inspection
Division of Water Qiiali chop r_ fy _Compliance inspe
_..1• Other.Agency Operation REVIew 'ma x a
0 Routine Q Complaint 0 Follow-up of DWQ inspection Q Follow-up of DSWC review O Other
Facility Number Date of Inspection ~�—
Time of Inspection 24 hr. (hh:mm)
Wermitted Certified (Q Conditionally Certified E3 Registered JE3 Not Opera fional Date Last Operated: ..........................
Farm Name: ...........
......... .1alxY .....79 ....... Count:........--...... Ali !✓ ........4.r...........--............
Q............... ....... ....I..............................
Owner Name:..........6(V14 .>......W ....'• �I ! f.. Iri................... Phone No:.................9 ..... � b.....................
Facility Contact: ............ :; !.h61ff1 l.,,nFF. � .,,. Title: Phone No:
Mailing Address: ... .... Tg..... .. .... Ft1............-. a��.l..i.2
-- Po,.... x..............�..........
Onsite Representative: Lam,(........ ►►--.yy.. ............. Integrator:........�Q................5...
Certified Operator:................................................................................................................ Operator Certification Number:
Location of Farm:
r-
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------t .
Latitude �• �° �• LongitudeF._1.i1�• �� �«
"Design Current.Current : Design Current
�.. -..,.
Swine,. Poalt . _
--Capacity Population �3 -- .. Capacity Population Cattle Capacity Population.
El Wean to Feeder
Feeder to Finish
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
Discharges & Stream Impacts
L Is any discharge observed from any part of the operation? ❑ Yes V
No
❑ischarge originatedat: ❑Lagoon ❑SprayField ❑Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
�r
Freeboard(inches)- a .-.............................................................................................. .............................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3/23/99
❑ Yes No
❑ Yes a
I�VA
❑ Yes
o
ElYesa
P
❑ Yes
[,No
❑ Yes 19 No
Structure 6
❑ Yes Continued oXNo
ack

Facility Number: 6 — Date of Inspection
5. 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 ARplication
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
13. Do the receiving crops differ with those designated in"theCerti
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
ied Animal Waste Management Plan (CAWMP)?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19: Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
. iVo •yiolatigtis'ox defcie,Acies mere noted• d�riitg #his:visit; • Y:ou will ->receive bo; further -' '
coi*4 6Tidence: Au' u' t this visit : ::: :
❑ Yes No
, X
❑ Yes No
❑ Yes No
❑ Yes 01 No
❑ Yes 19 No
❑ Yes 0 No
❑ Yes 10 No
❑ Yes No
('Yes ❑ No
,,❑``Yes ❑ No
[.Yes []No
❑ Yes 3� No
❑ Yes 0 No
❑ Yes DKNo
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes W No
❑ Yes kNo
❑ Yes K No
❑ Yes KNO
r. m 3 rye¢ R
Use diawtngs_ of facility to better explain'"sttuattons (use additional pages asnecessaiy) � µ _,cj­
I tot P
DAD $o,
T
Reviewer/Inspector Name o..r j
r ..
.
Reviewer/Inspector Signature. A Q Date, 6--1..
3/23/99

Facility Number: 0 —lid Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes (rNo
2$. Is there any evidence of wind daft during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes EYNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes XNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes [KNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes [kNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? 1[�Yes ❑ No
ttwon -Comments an orb _rawmgs: � a
5,2FIl � �, - b.� xJ OUJ
A,.! :bla, Orv�d
3123/99

f i,
Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
NP Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Facility Number OEi—�� j
0 Registered 0 Certified 13 Applied for Permit 8 Permitted
Farm Name: A;1r, _4�_ IVX
Date of Inspection
Time of Inspection Z/ = vU 24 hr. (hh:mm)
113 Not Operational 1 Date Last Operated:......... .................
County:.............0l.�iD...............................................
........ ............................... .......... .................. .......... ............................................
q o 29l 1�o
OwnerName:...........%elr✓'!................................. Phone No:.....1...........................----............................... .
.. .... .....'...... </f
Facility Contact:....... i.►.�!-. ...... Title Phone No: ....
Mailing Address:..: ...... .rr.....4) ...... ......T...t��f.......�i%�-2 fir....... � �.r.......fife....................................... ..........................
Onsite Representative:. ��([.!'!s?�..+le�s+.................. Integrator:... ... ,41✓r�f ...`..4........���•°r.E.-----
Certified Operator;....•.. �_v �r�� ........... Operator Certification Number;......9j2
Location of Farm:
. . ........................ . .......................................... . ......... . ................................................................................ ......... . ............. . ...... . ..................................... . .... 1. ­ _�w
- 1,71.,............................................................ .................. ......... - ................................ ...................................
Latitude # 46 Longitude 6 "
EJ Wean to Feeder
❑Layer ❑Dairy
❑ Non -Layer ❑Nan -Dairy
r
Feeder to Finish
�d
❑ Farrow to Wean
❑ Other }
❑ Farrow to Feeder
, Totat Design Capacity .
❑ Farrow to Finish
Gilts
a0
-'
:
y
❑ Boars
Number of? owns !Holding Ponds s l
0
❑ Subsurface Drains Present t] Lagoon Area © Spray Field Area
�` ` �``
...... ... ......
❑ No Liquid Waste Management System
s wac::-
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes C'No
2. Is any discharge observed from any part of the operation? ❑ Yes OtNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes O'No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes K'No
c. If discharge is observed, what is the estimated flow in gal/min? /11
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes XrNo
3. Is there evidence of past discharge from any part of the operation? ❑ Yes §ZNo
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes F No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes XNo
maintenance/improvement?
6. is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes P[No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes No
7125/97 111

Facility Number: Cy q —
8. Are there lagoons or storage ponds on, site which need to be properly closed?
Structures (Lagoons.Holdim Ponds. Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2
Identifier:
Freeboard (ft): ........., s,........
10. Is seepage observed from any of the structures?
Structure 3 Structure 4 Structure 5
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures Iack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type .....................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
[3. No.vitilations, or deftcieneies: were: noted during this.visiL- You:Will i-eceive:ita:ftirttier.::
.•cotT�spondence..aboufthis:visil'~-"•:�. :�:-:•.•.•.-:•:.::�. .•:• •:•:•..�:•..:•:•:,�.:.
❑ Yes A No
❑ Yes N[No
Structure 6
❑ YesA No
❑ Yes �kNo
Yes �l10 AP-1
❑ Yes qNo
❑ Yes A No
❑ Yes jgNO
❑ Yes . lrqo
XYes ❑ No
❑ Yes NNo
❑ Yes kNo
❑ Yes kNo
❑ Yes KNO
❑ Yes 4KNo
r
❑ Yes o
❑ Yes o
9
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: `fps Date: 7'

❑ Division of Soil and Water Conservation ❑ Other Agency
® Division of Water Quality
10 Routine O Complaint O Follow-up of DNVO inspection O Follow-up of DSWC review O Other
Date of Inspection
Facility number a 9 % Time of Inspection l .` 0 24 hr. (hh:mm)
© Registered E Certified © Applied for Permit © Permitted 113 Not O eratirrna! Date Last Operated: ...............
q ... County
Farm Name :R� "r ..... l Z........................................................................
OwnerName:......... ! rrrr '/. ...... . ...................I.............. Phone No:.......................................................................................
Facility Contact: ...................................... ......... Title Phone No
Mailing Address:......--- �...Q' ,�. 7 /!1-� f..�.r...r� �R....r 9� ..........................
Onsite Representative.. ..................... ............ . Integrator: ... r ......':°'t" ,.t?`"..5�.
Certified Operator .............. 6- /� �u. - ✓ 7 p —/ Op �........................................................................ Operator Certification Number:................................_.......
Location of Farm.
..... ......................................................................................................... ..................................................................................... .....................
i
......................
...rr.�s-.......�.P.....�d... a...... �............. .
Latitude ` .=1 64 Longitude • =` =11
®` Des rgn Ctt
Trent ; Design � Current- � Destgn "Current
CapacttyPapulahon-'' Poultry Capacity Population �Catle&Capacity Population
a
❑ Wean to Feeder
❑Layer : ❑ Dairy
Feeder to Finish
:.:
J❑ Non -Layer 1 ;" ❑ Non -Dairy
❑ Farrow to Wean
•„ .,: x, M
A� H -
❑ Farrow to Feeder
IN
Other_ R
ElFarrow to Finish"
Total Destgn Capacity
❑ Gilts;
" ❑ Boars
�& Tots S L'1?VT „
n.
NumH ber of Lagoons / olding Ponds ©, ❑Subsurface Drains Present 110Lagoon Ares ❑Spray Field Area `
RFGN: AN'> t %,�-pa.,
�. w'' ❑ No Liquid Waste Management System `
_ :: - , ,, _
_:```
General
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 disch ►rge is observed, dirt it reach Surface Water? (lf 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
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes ["No
❑ Yes ® No
❑ Yes -1P No
❑ Yes (;?No
Id%
❑ Yes No
❑ Yes No
❑ Yes �INo
❑ Yes tR No
❑ Yes KNo
❑ Yes (R No
Continued on back

Facility Number: 9 9 —
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes RNo
Structures (Lat=oons,Iiolding Ponds, FIush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes EANo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ...............................................................................................................................................:..
Freeboard (ft); .............
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenancelimprovement?
(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?
Waste Application '
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type �7fs4,�.r...............................................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?,
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss reviewrinspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0: No.violations.ar deficiencies.wer'enotedduring this:visit.- You4iB receive.no.fiirther_::
:•corresp[�sideuceab�outthis:visit:•:•:�:-:: :•:-:• :-.: :: •:-�. :-....:.:.:•.:::.•
❑ Yes WNo
❑ Yes R No
WSs ❑ No
❑ Yes Pit -No
❑ Yes RNo
❑ Yes 0 No
❑ Yes )Z No
❑ Yes JQ No
❑ Yes AU No
❑ Yes .0�-No
❑ Yes $1 No
❑ Yes No
❑ Yes P No
❑ Yes 1P No
❑ Yes A] No
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: 11-W ,�.,�,�� hate: %� %�