820006_INSPECTIONS_20171231

NORTH CAROLINA .�
Department of Environmental Qual

Type of Visit: (eMo mnliance Inspection U Operation Review U Structure Evaluation U Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 3 �u Arrival Time: - : 1 I Departure Time: [1 County: S s� /V Region: 2-0
Farm Name: GgAA1W -Z�c r" 6 Owner Email:
Owner Name: &-r'eAluoc?cY {��s Phone:
Mailing Address:
Physical Address:
Facility Contact: - v�`t� 5 p A'A-W f 6 C Title: Phone:
Onsite Representative: _ l( Integrator: 04 &S
Certified Operator: e— Lo- Certification Number: ryy-q' fz,
Back-up Operator:
Location of Farm:
Latitude:
73 8Y -�- — �o 13
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
rM Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle C►apacity Pop.
Dairy Cow
Wean to Feeder
I
INon-La er
I
Dairy Calf
Feeder to Finish 7
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Il P,oult , Ca aci. P,o ,
Lavers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Lavers
113eef Feeder
Boars
Pullets
I Beef Brood Cow
Qther
Other
Turke
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
❑L'No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
0 A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑'NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[ 14o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[] Yes
E No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facitity Number: - Dste of inspection: v
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [D-Ne"❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [J" 14A ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier-
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
K3'1No
❑ 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
❑.Pdo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
L" -Ko
❑ 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-idii'
❑ 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 [3-ITo— ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop TYpe(s): -ev_Mt-tI'l. _ � c � L C ✓� �'4 5S �
v
13. Sail Type(s): �Oai �lo Q
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑'iqo_ ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [ElIZ ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 0 ❑ NA [D 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
E]-Vo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[3-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 8-N-5 0 NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [2-No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes EJINo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

I ' F
acility Number: Z- Date of Ins ection: / T—a iVG
'r r
�4. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E3-Wo ❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
[J- �10 ❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
t ❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
No ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
ETNo ❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
!2Ko
❑ 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
Q o
❑ 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
Q--N-o
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�o
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[rNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
El"No
❑ NA
❑ NE
Comments (refer to question #I): Explain anyYES. answers and/or any; additional recor>imendati66s or any" other comments.;
Use drawungs:of facility to >zetter explain situations `(use:.addatianal pages as necessary).,
Ca iEra+1cK S - q- ! 6 Sfu.4e '�*-� -' �j -X7
3
a to 3 00- S 51
Reviewer/Inspector Name:
Reviewer/Inspector Signa
Page 3 of 3
tf OV�L� Phone:gto- 33`333y
lure: Date: / 3 'Tt' A t- 1 O
21412015

Faeility Number J - I , a J Division of Soil and Water Conservation
C7+ Other AgSncy
�t
Type of Visit: Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 15`Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: TRimDeparture Time: L=L L_I/D M County: %FY " Region: '
Farm Name: , Cy 1,,yt� F -4✓✓'' ^! Owner Email:
y
Owner Name: ,�✓`n(? L^z, Zoo cl (S.?-45_ [l— Phone:
Mailing Address:
Physical Address:
Facility Contact: ct, cA'f t S �jLuZ`L Title: Phone:
Onsite Representative: �r 77 Integrator:
Certified Operator: t]��R1S Jtl•S dr x Certification Number: �/ 70 S'
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
L.a er
Desigu Current
Capac ity Pop.
I
Cattle
I Dairy Cow
Design Current
PON
Capacity op.
Wean to Feeder
• �Jev —p—
I
INon-Layer
I I
Dairy Calf
Feeder to Finish
449 76 5 oLJ
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D , P,ouI
Layers
Non -Layers
Design Current
Ca ac" P,o
Dry Cow
Non -Dairy
Beef Stocker
Gilts
113eef Feeder
Boars
Pullets
s
Turke Poults
Other
I 113eef Brood Cow
I�WwTurke
Other
Other
DischaEges and Stream Im acts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes E�JTVo ❑ NA ❑ NE
❑ Yes
❑ No
�
❑ NE
❑ Yes
❑ No
nNA
❑ NE
❑ Yes
[:]No
e NA
❑ NE
❑ Yes
[]'No
❑ NA
❑ NE
❑ Yes
�o
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

lFacility Number: Date of Inspection:
Waste Collection & Treatment
4'Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0-No—
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
EJ-NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3,4 S 1( 2_0
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[i]`N o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[t]-K-b—
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
290
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
❑ 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
D-Ala
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
[]-Kii
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑-No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 13e fa"t '56 O G60.13 C_✓ � 5�
13. Soil Type(s): CcOIX LU 60
U
14. Do the receiving crops differ from those designated in the CAWMP? [-]Yes P-K6 ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Q'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 DNo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [:]Yes [2 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
ffNo
❑ 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
�o
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
allo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[0 No
❑ NA - ❑ NE
Page 2 of 3
21412015 Continued

Facili Number: .L - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes EJ- o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes E]-N� ❑ 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 ❑i No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑-No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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 E No ❑ NA ❑ NE
❑ Yes ❑'No ❑ NA ❑ NE
❑ Yes [ff'No ❑ NA ❑ NE
❑ Yes
[3-1�o
❑ Yes
eNNo
❑ Yes
0 No
❑ NA ❑ NE
❑ NA . ❑ NE
❑NA ❑NE
Comments (refeir to gnestion:#)::Explain any.YES a.`nswers and/or any additwnal'recoritinenditions or any other comments. ? , �.
Use drawin s of facili to better explain situations (use additional g t* p (°= pages as aecessa
[ 112, 3 ��
p.. , 83 '�J-%
U 0
C44 I t0-3 o 6 �-- c- ( I
Reviewer/Inspector Name:
Reviewer/Inspector Signattu
Page 3 of 3
Phone:T(O q33 3S3�
Date: L, l
21412015

0 Division of Water Resources
❑ Division of Soil and Water Conservation
❑ Other Agency
Factltty Number.
820006 Facility Status:
Active Permit: AWS820006
[] Denied Access
Inspection Type:
Compliance Inspection
Inactive Or Closed Date:
Reason for Visit
Routine
County: Sampson Region:
Fayetteville
Date of Visit:
03124/2017 Entry Time. 03:00 pm
Exit Time. 3:30 pm Incident g
Farm Name:
Owens Branch
Owner Email:
Owner.
Murphy -Brown LLC
Phone:
910-296-1800
Mailing Address: PO Box 487 Warsaw NC 28398
Physical Address: 12640 Baykin Bridge Rd Roseboro NC 28382
Facility Status: Compliant ❑ Not Compliant Integrator. Murphy -Brown LLC
Location of Farm: Latitude: 34° 52' 35"
On the north side of SR 1214 approx .6 miles west of McDaniel, NC.
Question Areas:
Dischrge & Stream Impacts
Records and Documents
Waste Col, Stor, & Treat
Other Issues
Longitude: 78' 28' 07"
0 Waste Application
Certified Operator. Robert T Young Operator Certification Number. 18461
Secondary OIC(s):
On -Site Representative(s): Name Title Phone
24 hour contact name Michael Ammons Phone : [phone]
On -site representative Michael Ammons Phone: [phone]
Primary Inspector. Robert Marble Phone:
Inspector Signature: Date:
Secondary Inspector(s):
Inspection Summary:
page: 1

Permit: AWS820006 Owner - Facility: Murphy -Brown LLC Facility Number. 820006
Inspection Date: 03/24/17 Inpsection Type: Compliance Inspection Reason for Visit Routine
Regulated Operations Design Capacity Current promotions
Swine
[] Swine - Feeder to Finish
4,896
❑ Swine - Wean to Feeder
11,200
Total Design Capacity: 16,096
Total SSLW: 996,960
Waste Structures
Disignated Observed
Type Identifier Closed Date Start Date Freeboard Freeboard
Lagoon
FINISHER
Lagoon
FINISHER 1
19.00
31.00
Lagoon
NURSERY 1
Lagoon
NURSERY 2
Lagoon
STAGE 1
19.00
21.00
Lagoon
STAGE 2
21.86
63.00
page: 2

Permit: AWS820006 Owner - Facility : Murphy -Brown LLC Facility Number: 820006
Inspection Date: 03/24/17 Inpsecction Type: Compliance Inspection Reason for Visit Routine
Discharmes & 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?
❑
❑ 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)
❑
❑ M
❑
2. Is there evidence of a past discharge from any part of the operation?
❑
0 ❑
❑
3. Were there any observable adverse impacts or potential adverse impacts to Waters of the
❑
0 ❑
❑
State other than from a discharge?
Waste Collection. Storage & Treatment
Yes
No Na No
4. Is storage capacity less than adequate?
❑
0 ❑
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (I.eJ large
❑
0 ❑
❑
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not property addressed and/or managed through a
❑
❑
❑
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
❑
❑
❑
8. Do any of the structures lack adequate markers as required by the permit? (Not applicable
❑
❑
❑
to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑
0 ❑
❑
maintenance or improvement?
Waste Application
You 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?
❑ ❑ ❑
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
❑
PAN?
❑
Is PAN > 10%/10 Ibs.?
❑
Total Phosphorus?
❑
Failure to incorporate manure/sludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
page: 3

of
Permit: AWS820006 Owner - Facility: Murphy -Brown LLC Facility Number. 820006
Inspection Date: 03/24/17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Waste Application
Yes No Na He
Crop Type 1
Coastal Bermuda Grass
(Hay)
Crop Type 2
Corn, wheat. Soybeans
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Autryville loamy sand, 0 to
6% slopes
Soil Type 2
Goldsboro foamy sand, 0 to
2% slopes
Soil Type 3
Nortolk loamy sand, 0 to 2%
slopes
Soil Type 4
Lakeland
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste
❑ ❑ ❑
Management Plan(CAWMP)?
15. Does the receiving crop and/or land application site need improvement?
❑ ❑ ❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
❑ ❑ ❑
determination?
17, Does the facility lack adequate acreage for land application?
❑ 0 ❑ ❑
18. Is there a lack of property operating waste application equipment?
❑ N ❑ ❑
Records and Documents
Yes
No Na No
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑
0 ❑ ❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑
■ ❑ ❑
If yes, check the appropriate box below.
WUP?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Lease Agreements?
❑
Other?
❑
If Other, please specify
21. Does record keeping need improvement?
❑
❑ ❑
If yes, check the appropriate box below.
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
❑
Weather code?
❑
page: 4

• .ti
Permit: AWS820006 Owner - Facility : Murphy -Brown LLC Facility Number. 820006
Inspection Date: 03/24/17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents
Yes
No He No
Rainfall?
❑
Stocking?
❑
Crop yields?
❑
120 Minute inspections?
❑
Monthly and 1" Rainfall Inspections
❑
Sludge Survey
❑
22. Did the facility fail to install and maintain a rain gauge? .
❑
M ❑
❑
23. If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment
❑
❑
❑
(NPDES only)?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
M ❑
❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check the
❑
M ❑
❑
appropriate box(es) below.
Failure to complete annual sludge survey
❑
Failure to develop a POA for sludge levels
❑
Non -compliant sludge levels in any lagoon
❑
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑
0 ❑
❑
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
M ❑
❑
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?
❑
❑
❑
(i.e., discharge, freeboard problems, over -application)
31. Do subsurface file 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
❑
❑
❑
CAWMP?
33. Did the Reviewer/Inspector fail to discuss reviewrinspection with on -site representative?
❑
0 ❑
❑
34. Does the facility require a follow-up visit by same agency?
❑
M ❑
❑
page: 5

0 Division of Water Resources
❑ Division of Soil and Water Conservation
❑ Other Agency
Facility Number: 820006 Facility Status: Active Permit: AWS820006
Inpsection Type: Compliance Inspection Inactive Or Closed Date:
Reason for visit: Routine County: Sampson Region:
Date of Visit: 09/2212015 Entry Time: 01:00 pm Exit Time: 2:00 pm Incident #
Farm Name: Owens Branch Owner Email:
Owner: Murphy -Brown LLC Phone:
Mailing Address: PO Box 487 Warsaw NC 28398
Physical Address: 12640 Bayidn Bridge Rd Roseboro NC 28382
Facility Status: 0Compliant ❑ Not Compliant Integrator. Murphy -Brown LLC
Location of Faun:
On the north side of SR 1214 approx..6 miles west of McDaniel, NC.
Question Areas:
Dischrge & Stream Impacts
Records and Documents
[] Denied Access
Fayetteville
910-296-1800
Latitude: 34° 52' 35" Longitude: 78' 28' 07"
Waste Col, Stor, & Treat Waste Application
Other Issues
Certified Operator: Robert T Young Operator Certification Number: 18461
Secondary OIC(s):
On -Site Representative(s): Name Title Phone
24 hour contact name Michael Ammons Phone: [phone]
Orrsite representative Michael Ammons Phone: [phone]
Primary Inspector: Robert Marble Phone:
Inspector Signature: Hate:
Secondary Inspector(s):
Inspection Summary:
page: 1

Permit: AWS820006 Owner - Facility : Murphy -Brown LLC Facility Number: 820006
Inspection Date: 09/22/15 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations Design Capacity Current promotions
Swine
❑ Swine -Feeder to Finish
4,896
❑ Swine - Wean to Feeder
11,200
Total Design Capacity: 16,096
Total SSLW: 996,960
Waste Structures
Disignated Observed
Type Identifier Closed Date Start Date Freeboard Freeboard
Lagoon
FINISHER
Lagoon
FINISHER 1
19A0
41.00
Lagoon
NURSERY 1
Lagoon
NURSERY 2
Lagoon
STAGE 1
19.00
21.00
Lagoon
STAGE 2
21.86
67.00
0
page: 2

Permit: AWS820006 Owner - Facility : Murphy -Brown LLC Facility Number: 820006
Inspection Date: 09IM15 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?
❑
0 ❑
❑
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
0 ❑
❑
b. Did discharge reach Waters of the State? (if yes, notify DWQ)
❑
0 ❑
❑
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑
0 ❑
❑
2. Is there evidence of a past discharge from any part of the operation?
❑
M ❑
❑
3. Were there any observable adverse impacts or potential adverse impacts to Waters of the
❑
0 ❑
❑
State other than from a discharge?
Waste Collection, Storage & Treatment
Yes No Na Ne
4. Is storage capacity less than adequate?
❑
0 ❑
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (Le./ large
❑
❑
❑
trees, severe erosion, 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 Na Ne
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°/6/10 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

If 6
Permit: AWS820006 Owner- Facility: Murphy -Brown LLC Facility Number: 820006
Inspection Date: 09/22/15 Inssection Type: Compliance Inspection Reason for Visit: Routine
Wa tB Application
Yes No Na Ne
Crop Type 1
Coastal Bermuda Grass
(Hay)
Crop Type 2
Com, Wheat, Soybeans
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Autryville loamy sand, 0 to
6% slopes
Soil Type 2
Goldsboro loamy sand, 0 to
2% slopes
Soil Type 3
Norfolk loamy sand, 2 to 6%
slopes
Soil Type 4
Lakeland
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 crap andfor 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?
❑ 0 ❑ ❑
1 a. Is there a lack of properly operating waste application equipment?
❑ E ❑ ❑
Records and Documents
Yes
No Na Ne
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑
0 ❑
❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑
■ ❑
❑
If yes, check the appropriate box below_
WUP?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Lease Agreements?
❑
Other?
❑
If Other, please specify
21. Does record keeping need improvement?
❑
0 ❑
❑
If yes, check the appropriate box below_
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
❑
Weather code?
❑
page: 4

Permit: AWS820006 Owner - Facility : Murphy -Brown LLC Facility Number:
820006
Inspection Date: 09/22/15 Inpsection Type: Compliance Inspection Reason for Visit:
Routine
Records and Documents
Yes No No 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?
❑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?
❑
❑
❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check the
❑
M ❑
❑
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?
❑
M ❑
[]
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
M ❑
❑
Other Issues
Yes
No No No
28. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑
0 ❑
❑
and report mortality rates that exceed normal rates?
29. At the time of the inspection did the facility pose an odor or air quality concern? If yes,
❑
❑
❑
contact a regional Air Quality representative immediately.
30. Did the facility fail to notify regional DWQ of emergency situations as required by Permit?
❑
❑
❑
(i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility?
11
■ ❑
❑
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 Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑
M ❑
❑
34. Does the facility require a follow-up visit by same agency?
❑
■ ❑
❑
page: 5

M Division of Water Resources
❑ Division of Soil and Water Conservation
❑ Other Agency
Facility Number. 820006 Facility Status: Active
Permit: AWS820006
] Denied Access
Iripsection Type: Compliance Inspection
Inactive Or Closed Date:
Reason for visit Routine County:
Sampson Region:
Fayetteville
Date of Visit: 08/20/2014 Entry Time: 08:30 am Exit Time: 9:30 am Incident #
Farm Name: Owens Branch
Owner Email:
Owner. Murphy -Brown LLC
Phone:
910-296-1800
Mailing Address: PO Box 487
Warsaw NC 28398
Physical Address: 12640 Baykin Bridge Rd
Roseboro NC 28382
Facility Status: Compliant ❑ Not Compliant Integrator:
Murphy -Brown LLC
Location of Farm: Latitude:
34° 52' 3Y Longitude:
78' 28- 07"
On the north side of SR 1214 approx..6 miles west of McDaniel, NC.
Question Areas:
Dischrge & Stream Impacts Waste Col, Stor, & Treat
Waste Application
Records and Documents Other Issues
Cerfified Operator: Danny Lee Tyner
Operator Certification Number:
28715
Secondary OIC(s):
On -Site Representative(s): Name Title Phone
24 hour contact name Michael Ammons
Phone: [phone]
On -site representative Michael Ammons
Phone: [phone]
Primary Inspector: Robert Marble
Phone:
Inspector Signature:
Date:
Secondary tnspector(s):
Inspection Summary:
page: i

Permit: AWS820006 Owner- Facility : Murphy -Brown LLC Facility Number: 820006
Inspection Date: 08/20/14 Inssection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations Design Capacity Current promotions
Swine
Ej Swine- Feeder to Finish
Swine - wean to Feeder
Total Design Capacity:
Total SSLW:
Waste Structures
Disignated Observed
Type Identifier Closed Date Start Date Freeboard Freeboard
Lagoon
FINISHER
Lagoon
FINISHER 1
19A0
Lagoon
NURSERY 1
Lagoon
NURSERY 2
Lagoon
STAGE 1
19.00
Lagoon
STAGE 2
21.86
page: 2

Permit: AWS820006 Owner - Facility : Murphy -Brown LLC Facility Number: 82000E
Inspection Date: 08/20/14 Inpsection Type: Compliance Inspection . Reason for Visit: Routine
Discharges 8, Stream Impacts
Yes
No Na No
1. Is any discharge observed from any part of the operation?
❑
[]
❑
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
■ ❑
❑
b. Did discharge reach Waters of the State? (if yes, notify 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
❑
❑
❑
State other than from a discharge?
Waste Collection, Storage 8, Treatment
Yes No Na Ne
4. Is storage capacity less than adequate?
❑
❑
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (LeJ large
❑
M ❑
❑
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a
❑
0 ❑
❑
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
❑
0 ❑
❑
8. Do any of the structures lack adequate markers as required by the permit? (Not applicable
❑
M ❑
❑
to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑
❑
❑
maintenance or improvement?
Waste APRlication
Yes No Na Ne
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ 0 ❑ ❑
maintenance or improvement?
11. Is there evidence of incorrect application?
❑ 0 ❑ ❑
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
❑
PAN?
❑
Is PAN > 101/6/10 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

• r
Permit: AWS820006 Owner- Facility : Murphy -Brown LLC Facility Number: 820006
Inspection Date: 08/20/14 Inppection Type: Compliance Inspection Reason for Visit: Routine
Waste Application
Yes No No No
Crop Type 1
Coastal Bermuda Grass
(Hay)
Crop Type 2
Com, Wheat, Soybeans
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Autryville loamy sand, 0 to
6% slopes
Soil Type 2
Goldsboro loamy sand, o to
2% slopes
Soil Type 3
Lakeland
Soil Type 4
Norfolk loamy sand, 2 to 6%
slopes
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 andfor land application site need improvement?
❑
M ❑
❑
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?
❑
❑
❑
18. is there a lack of properly operating waste application equipment?
❑
■ ❑
❑
Records and Documents
Yes No Na No
19, Did the facility fail to have Certificate of Coverage and Permit readily available?
❑
0 ❑
❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑
0 ❑
❑
If yes, check the appropriate box below_
WU P?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Lease Agreements?
❑
Other?
❑
If Other, please specify
21. Does record keeping need improvement?
❑ 0 ❑ ❑
If yes, check the appropriate box below.
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
❑
Weather code?
❑
page: 4

r
Permit: AWS820006 Owner - Facility : Murphy -Brown LLC Facility Number: 820006
Inspection Date: 08/20/14 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents Yes No Na No
Rainfall? ❑
Stocking?
Crop yields?
120 Minute inspections?
Monthly and 1" Rainfall Inspections
Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment
(NPDES only)?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check the
appropriate box(es) below:
Failure to complete annual sludge survey
Failure to develop a POA for sludge levels
Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report mortality rates that exceed normal rates?
29. At the time of the inspection did the facility pose an odor or air quality concern? If yes,
contact a regional Air Quality representative immediately.
30. Did the facility fail to notify regional DWQ of emergency situations as required by Permit?
(i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility?
If yes, check the appropriate box below.
Application Field
Lagoon / 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 ReviewerAnspector fail to discuss reviewrinspection with on -site representative?
34. Does the facility require a follow-up visit by same agency?
❑
ME]
❑
❑
ME]
❑
❑
ME]
❑
❑■❑❑
Yes No Na Ne
❑■❑❑
❑■❑❑
❑■❑❑
❑■❑❑
❑ ME] ❑
❑ ME] ❑
❑ ME] ❑
page: 5

0 Division of Water Resources
El Division of Soil and Water Conservation
❑ Other Agency
Facility Number: 820006
Facility Status: Active
Permit: AVVS820006
❑ Denied Access
Inppection Type: Compliance Inspection
Inactive Or Closed Date:
Reason for Visit: Routine
County:
Sampson Region:
Fayetteville
Date of Visit: 10/15/2013 Entry Time: 10:30 am Exit Time: 11:30 am Incident 0
Farm Name: Owens Branch
Owner Ema!I:
Owner. Murphy -Brown LLC
Phone:
910-296-1800
Mailing Address: PO Box 487
Warsaw NC 28398
Physical Address: 12640 Baykin Bridge Rd
Roseboro NC 28382
Facility Status: Compliant ❑
Not Compliant Integrator.
Murphy -Brown LLC
Location of Farm:
Latitude:
34' 52' 35" Longitude:
78' 28' Or
On the north side of SR 1214 approx..6 miles west of McDaniel, NC.
Question Areas:
Dischrge S Stream Impacts
Waste Col, Slor, & Treat
Waste Application
Records and Documents
Other Issues
Certified Operator: Danny Lee Tyner Operator Certification Number: 28715
Secondary OIC(s):
On -Site Representative(s): Name Title Phone
24 hour contact name Michael Ammons Phone. [phone]
On -site representative Michael Ammons Phone: [phone]
Primary Inspector: Robert Marble Phone:
Inspector Signature: Date:
Secondary Inspectorls):
Inspection Summary:
page: 1

Permit: AWS820006 Owner - Facility : Murphy -Brown LLC Facility Number: 820006
Inspection Date: 10/15/13 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations Design Capacity Current promotions
Swine
Swine - Feeder to Finish
Swine - Wean to Feeder
Total Design Capacity:
Total SSLW:
Waste Structures
Disignated Observed
Type Identifier Closed Date Stan Date Freeboard Freeboard
Lagoon
FINISHER
Lagoon
FINISHER 1
19.00
Lagoon
NURSERY 1
Lagoon
NURSERY 2
Lagoon
STAGE 1
19.00
Lagoon
STAGE 2
21.86
page: 2

0
Permit: AWS820006 Owner - Facility : Murphy -Brown LLC Facility Number: 820006
Inspection Date: 10/15/13 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Discharges & Stream Impacts
Yes No Na No
1. Is any discharge observed from any part of the operation?
❑
[]
❑
Discharge originated at:
Structure
[]
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
❑ M
❑
b. Did discharge reach Waters of the State? (if yes, notify DWQ)
❑
[10
❑
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑
[]
❑
2. Is there evidence of a past discharge from any part of the operation?
❑
❑
❑
3. Were there any observable adverse impacts or potential adverse impacts to Waters of the
❑
■ ❑
❑
State other than from a discharge?
Waste Collection, Storage & Treatment
Yes
No Na N�
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
❑
M ❑
❑
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a
❑
0 ❑
❑
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
❑
0 ❑
❑
8. Do any of the structures lack adequate markers as required by the permit? (Not applicable
❑
❑
❑
to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑
❑
❑
maintenance or improvement?
Waste Application
Yes No Na No
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ 0 ❑ ❑
maintenance or improvement?
11. Is there evidence of incorrect application?
❑ 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: AWS820006 Owner - Facility: Murphy -Brown LLC Facility Number: 820006
Inspection Date: 10/15/13 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Waste Application
Yes No Na Re,
Crop Type 1
Corn, Wheat, Soybeans
Crop Type 2
Coastal Bermuda Grass
(Hay)
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
AubWlle loamy sand, o to
6% slopes
Soil Type 2
Goldsboro loamy sand, 0 to
2% slopes
Soil Type 3
Lakeland
Soil Type 4
Norfolk loamy sand, 2 to 6%
slopes
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?
❑ E ❑ ❑
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?
❑ E ❑ ❑
1 B. Is there a lack of properly operating waste application equipment?
❑ 0 ❑ ❑
Records and Documents -
Yes
No Na Ne
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑
E ❑ ❑
20, Does the facility fail to have all components of the CAWMP readily available?
❑
0 ❑ ❑
If yes, check the appropriate box below.
WUP?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Lease Agreements?
❑
Other?
❑
If Other, please specify
21. Does record keeping need improvement?
❑
■ ❑ ❑
If yes, check the appropriate box below.
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
❑
Weather code?
❑
page: 4

a
Permit: AWS820006 Owner - Facility : Murphy -Brown LLC Facility Number: 820006
Inspection Date: 10/15/13 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents
Yes
No Na No
Rainfall?
❑
Stocking?
❑
Crop yields?
❑
120 Minute inspections?
❑
Monthly and 1" Rainfall Inspections
❑
Sludge Survey
❑
22 Did the facility fail to install and maintain a rain gauge?
❑
0 ❑
❑
23. if selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment
❑
❑
❑
(NPDES only)?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
❑
❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check the
❑
E ❑
❑
appropriate box(es) below:
Failure to complete annual sludge survey
❑
Failure to develop a POA for sludge levels
❑
Non -compliant sludge levels in any lagoon
❑
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑
0 ❑
❑
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
0 ❑
❑
Other Issues
Yes No Na No
28, Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑
M ❑
❑
and report mortality rates that exceed normal rates?
29, At the time of the inspection did the facility pose an odor or air quality concern? If yes,
❑
M ❑
❑
contact a regional Air Quality representative immediately.
30. Did the facility fail to notify regional DWO of emergency situations as required by Permit?
❑
0 ❑
❑
(i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility?
❑
M ❑
❑
If yes, check the appropriate box below.
Application Field
❑
Lagoon / Storage Pond
❑
Other
❑
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or
❑
M ❑
❑
CAWMP?
33. Did the Reviewerlinspector fail to discuss reviewfinspection with on -site representative?
❑
❑
❑
34. Does the facility require a follow-up visit by same agency?
❑
❑
❑
page: 5

type of visit: W compliance inspection U operation Review V structure Evaluation V 'rechnical Assistance I
Reason for Visit: 4D Routine O Complaint O Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit: 1 ,5-—1 Z Arrival Time: Departure Time: a County:.%i'+RS Region:
Farm Name: 00e C. Owner Email:
Owner Name: M U-Xpkm u C _ Phone:
Mailing Address:
Physical Address:
Facility Contact: I k-e— tA" r.14D IN-S Title: Phone:
Onsite Representative:
0
Certified Operator: Ta4n h N _T YTr
Bach -up Operator:y i c4v�— s,44b h
Location of Farm:
Latitude:
ME
Integrator: A upn
Certification Number: 2$'l!-5-
Certification Number: 2bc)q
Longitude:
Swine
Wean to Finish
Design
Capacity
C*urrent Design Current
Pop. Wet Poultry Capacity Pop.
La er
Design Current
Cattle Capacity Pop.
Da Cow
DairyCalf
Wean to Feeder
112d0
Non -La er
Feeder to Finish
Design Current
D , P,oul_ Ca aci P,o ,
Layers
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
"I
Other
Turke s
ey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes P No ❑ NA ❑ NE
❑ Yes
❑ No
Qg NA
❑ NE
❑ Yes
❑ No
[;§ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes NLNo ❑ NA ❑ NE
low
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes yl No ❑ NA ❑ NE
of the State other than from a discharge? TT
Page I of 3 21412011 Continued

Facifity Number: - Date of Ins ection: ,s Z
Z
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: 2-7(4-A- �7bS"
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ro Z
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify 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
[A No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[]Yes
[� No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[ No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes R No ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops
from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
❑ Yes
❑ NA
❑ NA
❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
❑ Yes
Qg No
❑ NA
❑ NE
❑ Yes
Y No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [V No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [�j 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 I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes M No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes q3 N
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
o ❑NA ❑NE
Page 2 of 3 214120.11 Continued

Wacility Number: Date of Inspection:
24.,Did the.facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours andlor document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
3 L 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?
Reviewer/Inspector Name:
Reviewer/Inspector Signature;
Page 3 of 3
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes �] No ❑ NA ❑ NE
❑ Yes 0 No 0 NA ❑ NE
❑ Yes $0 No ❑ NA ❑ NE
❑ Yes §3 No ❑ NA ❑ NE
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
Phone: -! 33BD
Date: ,J72
21412011

1!
Division of Water Quality
Facility Number ®- ® Division of Soil and Water Conservation0
© Other Agency
Type of Visit: 0 Compliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: 0 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name: dW+°.1�5 oyn Owner Email:
Owner Name:�1] Qtl'1� UL Phone:
Mailing Address:
Physical Address:
Facility Contact: i m yytWS —Title: Phone:
Onsite Representative:
N
Certified Operator:L�y}I I '�
Back-up Operator:}
Location of Farm:
Latitude:
Integrator:
Certification Number: a8`71S
Certification Number: `1(007�
Longitude:
V�
Design C*urre it
Design Current
12FWD_aaCi!t&V-'CP."
urrent
Swine C►apacity Pop.
Wet Poultry Capacity Pop.
Cattle
p.
Wean to Finish
La er
Da' Cow
Wean to Feeder
j� 2,(b
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current
Cow
Farrow to Feeder
P,oulh, C•.a aci_ Pio ,
Non -Dairy
Farrow to Finish
ers
Beef Stocker
Gilts
-La ers
Beef Feeder
Boars
TL'a
ets
Beef Brood Cow
e sOther
e Poults
Other
Other
Discharees and Stream Imnacts
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
M 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
P] NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
VI No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
1p No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3
21412011 Continued

Facili Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
jZ NA
❑ NE
Structure 1 Structure 2 Structure Structure 4
Structure 5
Structure 6
Identifier: I `5e3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): j r r7tiy
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�5No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
P No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
K7 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
t4 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
0 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
N No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. is there a lack of properly operating waste application equipment?
_Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
X No
❑ NA
❑ NE
❑ Yes
R] No
❑ NA
❑ NE
[] Yes
® No
❑ NA
❑ NE
❑ Yes [� No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes � No ❑ NA ❑ NE
❑ Yes " No ❑ NA ❑ NE
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [—]Yes P 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? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: Date of Inspection: 116
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?
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
[—]Yes
%) No
❑ NA
❑ NE
❑ Yes [73 No ❑ NA ❑ NE
[:]Yes CA No ❑ NA ❑ NE
❑ Yes ja No [ ] NA ❑ NE
❑ Yes " No
[:]Yes Vg No
❑NA ❑NE
❑ NA ❑ NE
Reviewer/InspectorName: j t 4LWUfe Phone: q%- 132
Reviewer/Inspector Signature: Date: 'T0/11
Page 3 of 3 21412011

N
'; 3

0 Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
- 0 Other Agency
Type of Visit Compliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit Routine O Complaint O Fallow up 0 Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: rDeparture Time: B�� County: Region:
Farm Name: O Owner Email:
Owner Name: 1 i I 1 VIA '/ wU, 11 Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
H
Onsite Representative:
Certified Operator: t?oAt)" l u /10-111'
Back-up Operator: Wr r 17 M
Location of Farm:
Design Current
Swine'' Capacity Population
❑ Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Boars
Other
❑ Other
Latitude: n°
Phone No:
Integrator:M&,1eh414ML,)("L L __-
Operator Certification Number: 0 `0 q/1<0,
Back-up Certification Number: 6 676
`6
= « Longitude: = ° = 6 = fi
Design Current Design
Wet Poultry Capacity Population Cattle Capacity=
Layer _ UDairy Cow
Non -Layer ❑ Dairy Calf
E]Dairy Heifer
Dry Poultry ❑ Dry Cow
❑N D
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
on- a
al
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number. of Structuresr,.0
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes oNo ❑ NA ❑ NE
❑ Yes
❑ No
P NA
❑ NE
❑ Yes
❑ No
"NA
❑ NE
0 NA
❑ NE
❑ Yes
❑ No
❑ Yes
10 No
❑ NA
❑ NE
❑ Yes
IN No
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No f
NA ❑ NE
q S grk
Strut en 2 Stru/ctur Structure 4 Structure 5 ucture 6
Identifier:v% j x !� tP
Spillway?:
Designed Freeboard (in):
'-1 c I
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? Cl Yes No ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ElNE
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.)
❑ FAN ❑ 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 ea
12. Crop type(s)M&rf'K koD
13. Soil type(s) i `-- '1 O6 r
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
No
❑ NA
❑ NE
No
❑ NA
❑ NE
ER No
❑ NA
❑ NE
1P No
❑ NA
❑ NE
Wo
❑ 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 Phone:
Reviewerlinspector Signature: Date:
Page 2 of 3 112128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Ph ❑ 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 El Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes P No ❑ NA ❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
914
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[�No
ElNA
ElNE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ElYes
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
rV{ No
❑ NA
ElNE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
MNo
❑ NA
ElNE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
10 No
❑ NA
❑ NE
Page 3 of 3 12128104

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: Z (} Departure Time: Q .fK ounty:
Farm Name: „ l�S Owner Email:
Owner Name: AV- 06—&Ww h �LLC Phone:
Mailing Address:
Physical Address:
Facility Contact: l v vl VI.-k Ot1S Title: Phone No:
Onsite Representative: Integrator: f "uyL&- - &tjyA, cQ(
Certified Operator: Pwv It, Operator Certification Number: ___ 26 ` 45-
Back-up Operator: W I-( Certification Number: AD 7,6
Location of Farm: Latitude: E--] o 0 U Longitude: = o =' = u
Design
Current Design Current
Design Current
Swine
Capacity
Population Wet Poultry Capacity Population
Cattle C*apacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
Wean to Feeder
I 1:a00
n-La er
❑ Dairy Calf
Feeder to Finish
Dry poultry
❑ La ers
❑Non -La ers
❑ Pullets
❑ Turkeys
❑ Dairy Heifer
Farrow to Wean
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Beef Stocker
❑ Gilts
❑ Beef Feeder
❑ Boars
❑ Beef Brood Co
Other
[Ell urkey Poults
❑ Other
Number of Structures:
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
4No
❑ 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 discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
[,&rNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
ERNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
El
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes VNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
00 NA
❑ NE
StructurenI SJtructure 2 Structure 3 Structure 4
Identifier: 2%6 —rT Xfxq 6 5-
Structure 5
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �j3 37ff
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes 06qo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes )9 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 ftNo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
El NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
r
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
[ONo
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
53No
❑ 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 Are
12. Crop type(s) La1V' S 6_20,5 ek,- cZ k )
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
V No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E?Aq0
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
O No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
b No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
91 No
❑ NA
❑ NE
Reviewer/inspector Name l.jf j Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents 19. Did the facility fail to have Certificate of Coverage & Permit readily available? ElYes bNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ONo ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Desig
n ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes allo ❑ 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 PNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes RNo ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
(9 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
6No
❑ 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
DNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ONo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
D2 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
09 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
6 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
WNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ti�No
❑ NA
❑ NE
Additional Comi;nents andlor:Dr`awings n:
Page 3 of 3 12128104

rz
Facility Number `Z rdp
PEDivision of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit `V Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit �011outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other [I Denied Access
L.
Date of Visit: 6 Arrival Time: Departure Time: Coun Region:
Farm Name: S C � Owner Email:
Owner Name: U'W >L� 1 ��Y1T Phone:
14
Mailing Address:
Physical Address: �,per
Facility Contact: Title: f�/� f" � Phone No: � j A) .29 _ ? W '/j
Onsite Representative: ' d�=-s Integrator: f r 1
Certified Operator: Operator Certification Number: I O
Back-up Operator: A Ail I Ln a/Back-up Certification Number:(j - 3
r
Location of Farm: Latitude: = e = 1f Longitude: = ° 0 t = it
Design Current Design Current
Swine , .,. Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish
can to Feeder I I 12tm.
21&eder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
Other
❑ Other
❑ Layer
❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
Design Current
Capacity. Populatio
- n
�
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: ®r
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 1P No ❑ NA ❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
,9NA
❑ NE
❑ Yes
❑ No
❑ Yes
V3No
❑ NA
❑ NE
❑ Yes
�PXo
❑ NA
❑ NE
5
12128104 Continued

Facility Number:,0 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Wo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes �INo ❑ NA ❑ NE
Structure 1 Structure 2 tructure 3 Structure 4 Structure 5 Structure 6
Identifier: .17 �2 -7 7
Spillway?: �7
Designed Freeboard (in): Il f 3
Observed Freeboard (in): 30
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes P,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 QNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ?1No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ yes [ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes , 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 II ❑ Evidence of Wind Drift El Application Outside of Area
12. Crop type(s) W —S' u m qr S M, C (4-
13. Soil type(s) A %A-, N $ G a -A
J
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
PQ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Wo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ yes
9To
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
�0 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
-h No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name ] ME (� T Phone: Q s3
Re-tiewer/Inspector Signature: Date:
12128100 ' Contkurkd

Facility Number: , Z Date of Inspection fa
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Wo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes J�r-No ❑ NA ❑ NE
the appropiate box. ❑ WUp ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes � No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
8INo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
gINA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�4No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
0No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
JNJ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
5INo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[] Yes
�INo
❑ 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
l
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
5j No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

Facility No,%-,). Ti In Time Out Date
Earm Name 0 Integrator
Owner t ��•-� _ Site Rep ky
Operator No -
Back -up No.
COC Circle: enera or NPDES
41
714
Design
Current
Design
Current
can - Fee
/ Z dv
Farrow - Feed
- mish
0
Farrow - Finish
-Feed -Finish
Gilts / Boars
arrow - can
Others
FREEBOARD:
Design
Observed
Crop Yield
Rain Gauge
Soil Test
Weekly Freeboard
Spray/Freeboard Drop _
Weather Codes
Waste Analysis:
Date
Wettable Acres _
Daily Rainfall
120 min Inspections
Nitrogen (N)
Sludge Survey
Calibration/GPM I
Waste Transfers
Rain Breaker
PLAT
1-in Inspections
Date Nitrogen (N)
Pull/Field Soil Crop Pan Window
i Y,_
02

Q Division of Water Quality blyyo
Facility Number Q Division of Soil and Water Conservation
Q Other Agency C
Type of Visit O Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral O Emergency O Other [I Denied Access
Date of Visit: Arrival Time: Departure Time: �� County: �109 Region
PZQ
Farm Name: O LLY_, ] &O- ocil Owner Email:
Owner Name: Qy.Q. f ` 42_j M � (3lJ( r _ Phone:
Mailing Address: 0 J 0\ �:? ` 1� f a
Physical Address:
Facility Contact: f"� \11i.IfV�Vhr9'l ` Title: L-' l Phone No:
Onsite Representatii,%+ `� VYl Integrator: IJI,Y
Certified Operator: r Z_Yy'\Operator Certification Number:
Back-up Operator: �l"t Back-up Certification Number:
Location of Farm: Latitude: o Longitude: = °
Design . Curren# Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
Eg:wean Feeder I zw I i1
'EaLFeeder to Finish $�
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design,, _Curren(,,,
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non-DaiEZ
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: FS1,
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
?NA
❑ NE
❑ Yes
❑ No
[>NA
❑ NE
❑ Yes
❑ No
ANA
❑ NE
❑ Yes
PNo
❑ NA
❑ NE
❑ Yes
ONo
❑ NA
❑ NE
12128104 Continued

- (3wa.`__S
P.
facility Number: :6�&Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: ai 66 A &, X) GS
Spillway?:
Designed Freeboard (in): t1
Observed Freeboard (in): 1 30
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 (KNo ❑ NA ❑ NE
❑ Yes ❑ No V4NA ❑ NE
Structure 5 Structure 6
❑ Yes �No
❑ Yes �, No
El NA El 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?
8. Do any of the stuctures lack adequate markers as required by the permit?
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
❑ Yes P%No
❑ Yes �, No
❑NA El NE
El NA El NE
❑ Yes ( 6No ❑ NA ❑ NE
10. Are there any required buffers, setbacks, or compliance alternatives that need []Yes *No [INA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. �y Vo ❑ NA El
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.
❑*Outside
PAN ❑ PAN > 10% or ] 0 Ibs ❑ Total Phosphorus El Failure to Incorporate Manure/Sludge into Bare Soil
of Acceptable Crop Window ❑ Evidence of Wind Drift ElApplication Outside of Area
12. Croptype(s) &X rr, CtT >n rf\• U Co.)
13. Soil type(s) -A No
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 7�LNo ❑ 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 OffNo❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes O No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
It, Q9j7Ur_d o,,. WkecJ c"
Pwtl `7a # q cn 5/41/0. opera-4, ��d Scti
Cf°Q L_Tu0C]1+ Skfe-5S.
1dtt&t
AiSD ncit �� PtaKf Cs�te �u< �� Wei s.�;yi�s- CQnd�fiv..
Reviewer/Inspector Namei
m:F— WbQ Phone•
Reviewer/Inspector Signature:C.42AL�-�10Date::j
no ry D�C n
I2128104 Continued

Facility Ndmber: -g Date of Inspection I �1 _f IU1J
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 'kqo El NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ElNA ❑ NE
Elthe approprrate box. WUpEl❑ Design ❑Maps ❑Other
Checklists �bNo
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
kNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
)(No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
&No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes 0 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
0 Yes
JpcNo
❑ 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

lFacility No. uu Time In Time Out Date
Farm Name Integrator
Owner ]a t' Ql� �`�" Site Rep vx
Operator No.
Back-up
COC
Li Circle: General or
Design
Current
Design
Current
d
Farrow — Feed
Wean — Finish
Farrow — Finish
r Finish
Gifts I Boars
Fa
Others
REEBOAR De
n
Sludge Su N�' 2`
Cr field
Rain Gauge
Soil Test PLAT
Weekly Freeboard Daily Rainfall
Spray/Freeboard Drop
Weather Codes
Observed
f �lihra4innlfrP�lA
Waste Transfers
Rain Breaker
Wettable Acres
—� 1-in Inspections
120 min Inspections
Waste Analysis:
F M 1 Ai Z.
Date
Nitrogen (N)
GI
"2:.-
1,9 L , .1-N
Xi
/ • 3 z • %
r tl) _Z_
Date Nitrogen (N)
r� t .4 1-79
IMPM
�..
a
r
_..
. -t W 40
r •.

0
sion of Water. Quality.
Facility Number © O Division of Soil and Water Conservation sl�is•
�.
,.. D Other Agency -
Type of Visit 6iffompliance 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: O- %� Arrival Time: 7 E Departure Time: rD� County: Region:
Farm N
Owner Email:
Owner NameGy'e ��` /�.-i _ Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:�—
Certified Operator: n4 i L1 r- _S
1 /
Back-up Operator: �f)�� n tE n it
Location of Farm:
Phone No:
Integrator: 1W111 r
Operator Certification Number—,, s?
Back-up Certification Number:
Latitude: = o = d Longitude: =1 ° = f
.. ..s��3:•°k�s"x �?�s
- ' 1 De'slgn `` rie& "Cu"Design Current Design Current
Swine Capacity Population Wet.Poultry Capacity ..Population Cattle Capacity< Pdpulaha
❑
Wean to Finish
i
Wean to Feeder
I -p
Feeder to Finish
to
❑
Farrow to Wean
❑
Farrow to Feeder
❑
Farrow to Finish
I
❑
Gilts
❑
Boars
ier`
Other
❑ Layer
❑ Non -Layer
Dry Poultry
U Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes M-No ❑ NA ❑ NE
❑ Yes
tZNo
❑ NA
❑ NE
❑ Yes
V,No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[allo
❑ Yes
(.No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
12128104 Confinued

Facility Number: - D
Date of Inspection 9`� to
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 l
Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
-d
Designed Freeboard (in): 7
Observed Freeboard (in): 3 �
3s
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 EgNo ❑ NA ❑ NE
❑ Yes O-No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 2!.No ❑ NA ❑ NE
❑ Yes ZLNo ❑ 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 9 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ® No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes MNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes � No ❑ NA El NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] O lbs ❑ Total Phosphorus [:]Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes f,No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes RNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes E, 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 N No ❑ NA ❑ NE
❑ Yes allo ❑ 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 dx_- "--.. I Phone: 2i0 nlf � 33 O
Reviewer/Inspector Signature: Date:
rage Z' uJ -Y JZ/Zoiv4 uununuea

Facility Number: p Date of Inspection �}
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes M No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes lA No ❑ NA ❑ NE
the appropriate box.
❑ W[JP El Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E9 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
JNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
5INo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[RNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
W No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
J4 No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Z[No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
j4No
❑ 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
MM, 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
CK 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
(9 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
MNo
❑ NA
❑ NE
Comments and/or
Page 3 of 3 12128104

Type of Visit (D-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: {t[ -�-1 Arrival Time: p Departure Time: G rpD County -L— Region:
Farm Name: (J W �rt.S J31'ctr1G�► r €a�rrl %llGs� Owner Email:
Owner Name: Phone:
Mailing Address: 4 a 757 D 5=;
Physical Address:
Facility Contact: j 8r�fi �lt7aTitle: Phone No:
Onsite Representative: Sdx-*$. -r- Integrator:
Certified Operator: �5��+�t,--=
Back-up Operator:
Operator Certification Number: ZgL— v
Back-up Certification Number:
Location of Farm: Latitude: 0 O [= ` = Longitude: = ° = L = "
Design Current.
Design Current
DesignCurrent
Swine Capacity
Population
�'et Poultry Capacity Population
Cattle
Population
❑ an to Finish
❑ Layer
❑ Da' Cow
Wean to Feeder %
❑ Non —Layer
❑ DairyCalf
® Feeder to Finish
❑ Da Heifer
❑ Farrow to Wean
Dry Poultry
❑ Cow
❑ Farrow to Feeder
❑
Non -Dairy
❑ Farrow to Finish
❑ Layers
❑
Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turke s
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures: EE
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
MNo
❑ 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
W1 No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
[ 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
No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes V4 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 5& No ❑ NA [:]NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: a f e2 in �5 t ,df
Spillway?: >Its
Designed Freeboard (in): % j L9 f, 5-'� d G}
Observed Freeboard (in): f �} `21 j 9
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes %No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes VtNo ❑ 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 5No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [�No El NA El 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 gNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes N No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [A 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 of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAW -MP?
❑ Yes
[ANo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[&No
Cl NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination
, ❑ Yes
O No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
&No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
allo
❑ NA
❑ NE
Reviewer/inspector Name 6vt` Phone: ��t. / s1�/
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �[ No El NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes KNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design [I Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Ryes ❑ No ❑ NA ❑ NE
X Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking . El 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 A No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[A No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
U& No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
� No
El NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
(5No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
PRNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
54 No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[d 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
,-E,,
9No
❑ 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
33. Does facility require a follow-up visit by same agency?
❑ Yes
[o No
❑ NA
❑ NE
Additional Comments and/or Drawin s:
g
W r-&.1 Pa4,L, U 5-eJ o m 9 R .2 o r' 45'a
41'-5 GY i J Not GGz a apr o Pe rt enn�.Ci
I2128/04

Facility Number Date of Visit: O Time: = �S
rQNo—tOperational Q Below Threshold
Permitted R Certified © Conditionally Certified 13 Registered Date Last Operated or Above Threshold: _.
Farm Name: ..... __.�9- ._....._._... ....... County:
Owner Name: _tAyr-e� — ' w ►!` _ , bone No: 0 -2_0 — 2!1
....... .... '' II _......_ 2.(......._ w_.
Mailing Address:..__ P. 0 _ — Q _ Jr
Facility Contact: .._ sGc ,tt s rr _ �t►!S� ..__ Title:..........._._....----- Phone No. .�d�Z�Q �,�l. .....
Onsite Representative:.._.�� �c�F�. W ! .. . _. Integrator:.
Certified Operator:..,,,,,,=,Zy� st_ ,,,_ULvL n-g,� ,_--- _T Operator Certification Number:., 9! 98,1,,.W.
Location of Farm:
KSwine ❑ poultry ❑ Cattle ❑ Horse Latitude • & " Longitude • 6 94
Desr�g� Currents = Design Current--- " - ? , I i-si ,�,T La Carresrt h
Swine Ca Pt►ultryCa Cattle Po txta
a _ .. ci �;Pa niatiba r,c
Wean to FeederjZpp
Numlatfloini
"❑Layer Dairyer
�= Nan-Layer❑Non-Dairy
to Finish
Number of Lagoons
Farrow to Wean
Other
Farrow to Feeder
Total Design Capacity= � f (o.Oq F
Farrow to Finish
8 Stream lmaacis
L Is any discharge observed from any part of the operation?
❑ Yes KNo
Discharge originated at: ❑Lagoon [I 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 galliitia?
. 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 ;ff No
Waste Collection &Treatment
4. Is storage capacity (freeboard plus storm storage) Less than adequate? ❑ Spillway ❑Yes JgNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure S Structure 5
Identifier: ...�...5 �....._._._ __.... s .�...___...�._�r...._....................._..... ._...�....._..............__... _�._.........._......_..._..
Freeboard (inches): 7i
12/I2/03 Continued

Facility dumber: 6Z — r0 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes JXNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes ONo
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes KNo
8. Does any part of the waste management system other than waste structures require maintenancerimprovement? ❑ Yes ;(No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes P.No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes 6No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes O ,No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type joy"% W k ea7k . "r-N . i �{ �� . S w%kaq a r&► 64-
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 a No
b) Does the facility need a wettable acre determination? ❑ Yes IffNo
c) This facility is pended for a wettable acre determination? ❑ Yes 2LNo
15. Does the receiving crop need improvement? ❑ Yes JKNo
16. Is there a lack of adequate waste application equipment? ❑ Yes 29:No
Odor Issues
17. 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?
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 P—No
roads, building structure, andfor 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 EJ No
Air Quality representative immediately.
Camntent4 {refer #o _stueshon-fir Eiiplam any. YF sii sweirs ar any: endauons cr aay ot> cr comments w�
Use dra of to better situat'ons. nse sdthtioi al
! S ty expla { l? i9) = Feld ❑ Final Notes
as aecessaCopy
, x _
a
15 • �•t c � r w� �eav-� +v c .r� wig-ea.'�" i to Kr �-� week o� so o�-K� �. � �-�.� r�
e� � �►�ece�o..�e.[y
cocks 0,-4 0. -Ae" 3
`�', Wee�S a.�o-� �ooxS a-tt {n �Y Wf SC�e'F��.-� r►e�t� �,.�ee_�,
Reviewer/Inspector Name a ;°o
Reviewer/Inspector Signature: Date:
12112103 1 Continued

Facilitf Number: ig — (p Date of Inspection i1
Reauired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? [:]Yes J�Wo
22. Does the f5c�ility fail to have all compnents of the Certified Animal Waste Management Plan readily available?
(ie/ WUll,'checklisMe;desig�mapa, etc.) ❑ Yes gNo
23. Does record keeping a improvement? If yes, check the appropriate box below. El Yes gNo
❑ Waste Applicati Freeboav /❑ Waste Analysla- ❑ Soil Samplingle'
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
KNo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
P No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
P%No
28. Does facility require a follow-up visit by same agency?
❑ Yes
E4 No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
[:1 Yes
KNo
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
;.Yes
❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
;&No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
KNo
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
$1No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
]&No
35. Does record keeping for NPDES required forms need` If yes, check the appropriate box below.
❑ Yes
KNo
improvement?
❑ Stocking Form/0 Crop Yield Forpz - ❑ Rainfal as 0on After 1" Rai
❑ 120 Minute Inspection[] Annual Certification Form
12112103

Site Requires Immediate Attention: N
Facility No. z� 0 ;
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERA17ONS SITE VISITATION RECORD
DATE: , 1995
Time:
Farm Name/Owner: S t
Mailing Address: Z
County: J
Integrator: V (L 1= A 2 1 O L- Phone: 0 0 — Z l
On Site Representative: 1 6 �! Phone: alo
Physical Address/LA=tion: sa,1 Zd yr
F
Type of Operation: Swine Poultry Cattle
Design Capacity: Z-2- k ,c4 Number of Animals on Site: ] ZZ to
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: 0 ,
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately l Foot + 7 inches) Yes or No Freeboard:_�_Ft. _Inches
Was any seepage observed from the lagoo�bls
es o�as any erosion observed? Yes or o
Is adequate land available r ra Ye6 the cover cr ad uate? Yes or No
e9 sP Ycrop
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellinu?(Y—Jor No
100 Feet from Wells?
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or o
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue : Yes or
Is animal waste discharged into water state by man-made ditch, flushing system, or other
similar man-made devices? Yes o o If Yes, Please Explain.
Does the facility maintain adequate waste management MY6s
lumes of manure, land applied
spray irrigated on c acres a wit ve No I
Additional Comments: —& A .Cyunc
OD�
Inspector Name
cc: Facility Assessment Unit Use Attachments if Needed.

f
Site Requires Immediate Attention: AD
Facility No. ` (o
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: k -1 P\u , 1995
Time:
Farm Name/Owner: AAr► CL,V u e► t
Mailing Address: 6t i o a -e borZZ 2
Coup : lz—::> PnP 5 a NJ
integrator: fLR A 6'4 'TDC, Phone:- j - sjO
On Site Representative:. ._ _ QA gY Zt_13 V-_ L 'oi Phone: ID 5 o"z-
Physical Address/Location: 'I Ya�Ws_� � ,,` �-iyi •, t� �� r��;�l C ��� c
av' boYkr•� ld��. rQ_ c 13
Type of Operation: Swine Poultry Cattle
Design Capacity: ill Number of Animals on Site: 114 20 a
�
D�E`M Certification Number: A °
ACE_
DFM Certification Number: ACNEW
Latitude: ° w Longitude: w
Circle Yes or No
Does the Animal Waste Lagoon sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches Yes r No Actual Freeboard: 5 Ft. _Q_Inches
Was any seepage observed from the n(s)? Yes or No Was any erosion ob ed? Yes or
Is adequate land available for spray? ge or No Is the cover crop adequate? es No
Crop(s) being utilized: U
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellin es r
100 Feet from Wells? or o
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or +la�?
No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue L e: Yes or
Is animal waste discharged into water o�the state by man-made ditch, flushing system, or other
similar man-made devices? Yes � If Yes, Please Explain.
Does the facility maintain adequate waste management s (volumes of manure, land applied,
spray irrigated on sppfific acreage with cover crop)? Y or No +11
Additional Comments:to4V 3/
0
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.