820030_INSPECTIONS_20171231

NORTH CAROLINA .�
Department of Environmental Quay

ff
Type of Visit: omyjhrnce Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine O Complaint O Follow-up 0 Referral O Emergency _0 Other O Denied Access
Date of Visit: V-tc Arrival Time: O Departure Time: County: q %Ps ,C>f7
Farm Name: pno Nj1.4, � � Owner Email:
Owner Name: f l o f Ufa f [t,%`_fAr tj-C Phone:
Mailing Address:
Physical Address:
Facility Contact: (?-{j.Uj\ 5 (�; 0JW t. C Title: Phone:
Region:T=�Za
Onsite Representative: ` r Integrator: -- ---dL i5 ' S
Certified Operator: &Wl p- Certification Number: 16 kz
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design "Current
Design
Current
Design Current
Swlne
Capaclty Pop.
Wet Poultry
Capacity
Pop:
Cattle Capacity Pap,
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
t-f0
Dairy Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D . PlI'MI .
Ca acit
IN
Non-Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
=
Beef Feeder
Boars
Pullets
-
Beef Brood Cow
Turkeys
Other
Turke Paults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes CD --No 0 NA [] NE
a. Was the conveyance man-made? ❑ Yes ❑ No 0-KA- ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No 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 O'llo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [] N ❑ NA ❑ NE
of the State other than from a discharge?
Page l of 3 21412015 Continued

Facili Number: - 30 Date of Inspection: r7,r K ti
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[• -1qo-
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[-]No
[3-N7�_
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[D-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
D.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 DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
Cg- o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
ED_bIe`
❑ 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
FLJ_7do
❑ NA
❑ NE
maintenance or improvement?
Waste Api3lication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Z>43r
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes L -N-o— [] NA ❑ NE
[] Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN El 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): L' o— P
13. Soil Type(s): VV /
14. Do the receiving crops differ from those designated in the CAWMP? [] Yes ❑4o ❑ NA ❑ NE
I5. Does the receiving crop and/or land application site need improvement? ❑ Yes [g'No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes EB-4 o_ ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes I D'1Vo ❑ NA 0 NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes to ❑ NA ❑ NE
Required Records & Documents ,__,2�
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes [ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ErNoS ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 'Co❑ NA ❑ NE
Page 2 of 3 21412015 Continued

00
Facility Number: - J Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E2-NQ ❑ NA ❑ NE
25.4s the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes L11"c 0 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 [D-Ko— ❑ 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?
24. 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
[Z>i5'
❑ NA
❑ NE
❑ Yes
to
❑ NA
❑ NE
❑ Yes
D<o
❑ NA
❑ NE
❑ Yes
io
❑ NA
0 NE
❑ Yes [T No
❑ Yes E3 No
❑ Yes [�No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refe16to-' ii�dinflEx�"" li�in"ariy �Y��ES pnswers`:'iindlor, any,additiot�ai recommendi�"tions °ar ariy other cot iments:':
w� i'wsT.r '',w.7 y'ds,3'u"�".a$r a:c.:� .. a�J d - - ',:.�
Use drawin s oftfac.ih. ex laihisituatlons (use;addltionah a e"s as, necessa ) ,; rc
CCU(L
CJ glo- dog- 6 gSr
Reviewer/inspector Name: 13C U
Reviewer/inspector Signature:
Page 3 of 3
Phone:[l03 3 33
Date:lVj I (J
21412015

■ Division of Water Resources
❑ Division of Soil and Water Conservation
❑ Other Agency
Facility Number:
820030
FacilityStatus: Active Permit: AWS820030
E] Denied Access
Inpsection Type:
Compliance Inspection
Inactive Or Closed Date:
Reason for Visit:
Routine
County: Sampson Region:
Fayetteville
Date of Visit:
03/24/2017 Entry Time: 10:00 am Exit Time: 11:00 am Incident 6
Farm Name:
CC/Tomahawk Farm
Owner Email:
Owner:
Murphy -Brown LLC
Phone:
910-296-1800
Mailing Address:
PO Box 487
Warsaw NC 28398
Physical Address:
3608 CC Rd
Harrells NC 28444
Facility Status:
Compliant ❑
Not Compliant Integrator, Murphy -Brown LLC
_
Location of Farm:
Latitude: 34' 43' 31" Longitude:
78' 19' 60"
On the west side of SR 1131 approx, 1 mile north of its intersection with Hwy 41 at Tomahawk, NC.
Question Areas:
Dischrge 6 Stream Impacts Waste Col, Star, & Treat
Waste Application
Records and Documents Other Issues
Certified Operator: Eddie L Jones
Operator Certification Number: 16291
Secondary OIC(s):
On -Site Representative(s): Name
Title Phone
24 hour contact name Mike Ammons
Phone:
On -site representative Mike Ammons
Phone
Primary Inspector: Robert Marble
Phone:
Inspector Signature:
Date:
Secondary Inspector(s):
Inspection Summary:
page: 1

r. 14
Permit: AWS820030 Owner - Facility : Murphy -Brawn LLC Facility Number: 820030
Inspection Date: 03/24/17 Inppection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations Design Capacity Current promotions
Swine
=,mneeeder to Finish 12,240
Total Design Capacity: 12,240
Total SSLW: 1,652,400
Waste Structures
Disignated Observed
Type Identifier Closed Date Start Date Freeboard Freeboard
Lagoon 1 58.00
page: 2

Permit: AWS820030 Owner - Facility : Murphy -Brawn LLC Facility Number: 820030
Inspection pate: 03/24/17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Dischames & Stream Impacts
Yee
No No No
1. Is any discharge observed from any part of the operation?
❑
M ❑
❑
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
❑ 0
❑
b. Did discharge reach Waters of the State? (if yes, notify DWQ)
❑
❑
❑
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑
[IN
❑
2. Is there evidence of a past discharge from any part of the operation?
❑
N ❑
❑
3. Were there any observable adverse impacts or potential adverse impacts to Waters of the
❑
0 ❑
❑
State other than from a discharge?
Waste Collection, Storaue & Treatment
Yes
No No 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.e./ large
❑
❑
❑
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a
❑
0 ❑
❑
Waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
❑
0 ❑
❑
8. Do any of the structures lack adequate markers as required by the permit? (Not applicable
❑
❑
❑
to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other then the waste structures require
❑
0 ❑
❑
maintenance or improvement?
Waste Application
Yes No Na No
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ M ❑ ❑
maintenance or improvement?
11. Is there evidence of incorrect application?
❑ 0 ❑ ❑
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
❑
PAN?
[]
Is PAN > 10%110 lbs.?
❑
Total Phosphorus?
❑
Failure to incorporate manure/sludge into bare soil?
❑
Outside of acceptable crop window?
[]
Evidence of wind drift?
❑
Application outside of application area?
❑
page: 3

Permit: AWS820030 Owner - Facility : Murphy -Brown LLC Facility Number: 820030
Inspection Date: 03/24/17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Waste Anolication
Crop Type 1
Coastal Bermuda Grass
(Pasture)
Crop Type 2
Small Grain Overseed
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Cainhoy sand, 0 to 5%
slopes
Soil Type 2
Leon sand, 0 to 2% slopes
Soil Type 3
Tomahawk sand
Soil Type 4
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste
❑
0 ❑
❑
Management Plan(CAWMP)?
15. Does the receiving crop and/or land application site need improvement?
❑
0 ❑
❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
❑
N ❑
❑
determination?
17. Does the facility lack adequate acreage for land application?
❑
0 ❑
El
18. Is there a lack of properly operating waste application equipment?
❑
0 ❑
❑
Records and Documents
Yes
Ng No No
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
C
0 ❑
❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑
0 ❑
❑
If yes, check the appropriate box below.
WUP?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Lease Agreements?
Other?
❑
If Other, please specify
21. Does record keeping need improvement?
❑
❑
❑
If yes, check the appropriate box below.
Waste Application?
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
❑
Weather code?
❑
Rainfall?
[]
page: 4

Permit: AWS820030 Owner -Facility: Murphy -Brown LLC Facility Number. 820030
Inspection Date: 03/24/17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Recorde and Documents
Ygj
No Na No
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 fall to install and maintain a rainbreaker on irrigation equipment
❑
M ❑ ❑
(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?
❑
0 ❑ ❑
Other Issue$
Yea
No Na He
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?
❑
0 ❑
❑
(i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility?
❑
0 ❑
❑
If yes, check the appropriate box below.
Application Field
❑
Lagoon 1 Storage Pond
❑
Other
❑
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or
❑
M ❑
❑
CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑
■ ❑
❑
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: 820030 Facility Status: Active Permit: AWS820030 ❑ Denied Access
Inpsectlon Type: Compliance Inspection Inactive Or Closed Date:
Reason for Visit: Routine County: Sampson Region:
Dale of Visit: 07129/2015 Entry Time: 01100 pm Exit Time: 2:00 pm Incident #
Farm Name: CC/Tomahawk Farm Owner Email:
Owner: Murphy -Brown LLC Phone:
Mailing Address: PO Box 487 Warsaw NC 28398
Physical Address: 3608 CC Rd Harrells NC 28444
Facility Status: Compliant ❑ Not Compliant Integrator: Murphy -Brown LLC
Location of Farm: Latitude: 34' 43' 31" Longitude: 78' 19' 60"
On the west side of SR 1131 approx. 1 mile north of its intersection with Hwy 41 at Tomahawk, NC.
Question Areas:
Dischrge & Stream Impacts
Records and Documents
Waste Cal, Stor, & Treat Waste Application
Other Issues
Fayetteville
910-296-1800
Certified Operator: Wayne 0 Sanderson Operator Certification Number: 17903
Secondary OIC(s):
On -Site Representative(s): Name Title Phone
24 hour contact name Mike Ammons Phone
On -site representative Mike Ammons Phone
Primary Inspector:
Inspector Signature:
Secondary Inspector(s):
Inspection Summary:
4
Robert Marble
Phone:
Date:
page: 1

Permit: AWS820030 Owner - Facility : Murphy -Brown LLC Facility Number: 820030
Inspection Date: 07/29/15 Inppection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations
Design Capacity Current promotions
Swine
[� Swine - Feeder to Finish 12,240
Total Design Capacity: 12,240
Total SSLW: 1,652,400
pyaste Structures
Dlsignated Observed
Type Identifier Closed Date Start Date Freeboard Freeboard
Lagoon 1 44.00
page: 2

Permit: AWS820030 Owner —Facility : Murphy -Brown LLC Facility Number: 820030
Inspection Data: 07/29/15 Inppection Type: Compliance Inspection Reason for Visit: Routine
Discharges & Stream Impacts
Yes No No No
1. Is any discharge observed from any part of the operation?
❑
[]
❑
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
130
❑
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)
❑
EIN
❑
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
❑
M ❑
❑
State other than from a discharge?
Waste Collection Storage & Treatment
Yes
No Na No
4. Is storage capacity less than adequate?
❑
M ❑
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (I.e./ large
❑
0 ❑
❑
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a
❑M
❑
❑
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
❑]
❑
S. Do any of the structures lack adequate markers as required by the permit? (Not applicable
❑
0 ❑
❑
to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑
0 ❑
❑
maintenance or improvement?
Waste Application
Yes No Na No
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ M ❑ ❑
maintenance or improvement?
11. Is there evidence of incorrect application?
❑ 0 ❑ Cl
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: AWS820030 Owner - Facility : Murphy -Brown i-LC Facility Number. 820030
Inspection Date: 07/29/15 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Waste Application
Yes No Na No
Crop Type 1
Coastal Bermuda Grass
(Pasture)
Crop Type 2
Small Grain Overseed
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Cainhay
Soil Type 2
Leon
Soil Type 3
Tomahawk sand
Soil Type 4
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste
❑
so
❑
Management Plan(CAWMP)?
15. Does the receiving crop and/or land application site need improvement?
[]
M ❑
❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
❑
0 ❑
❑
determination?
17. Does the facility lack adequate acreage for land application?
❑
❑
❑
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 ❑
n
If yes, check the appropriate box below.
WU P?
n
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?
n
Weather code?
❑
Rainfall?
0
Stocking?
❑
page: 4

Permit: AWS820030 Owner- Facility : Murphy -Brown LLC Facility Number:
820030
Inspection Date: 07/29/15 Inpsection Type: Compliance Inspection Reason for Visit:
Routine
Records and Documents
Yea
No Na No
Crop yields?
❑
120 Minute inspections?
❑
Monthly and 1" Rainfall Inspections
❑
Sludge Survey
❑
22, Did the facility fail to install and maintain a rain gauge?
❑
❑
❑
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
❑
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?
❑
MEI
❑
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
M ❑
❑
Other Issues
Yos No Na Na
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?
❑
0 ❑
❑
(i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility?
❑
0 ❑
❑
If yes, check the appropriate box below.
Application Field
❑
Lagoon / Storage Pond
❑
Other
❑
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or
❑M
❑
❑
CAWMP?
33. Did the Reviewer/Inspector fail to discuss reviewlinspection with on -site representative?
❑
❑
❑
34, Does the facility require a follow-up visit by same agency?
❑
0 ❑
❑
page: 5

0 Division of Water Resources
❑ Division of Soil and Water Conservation
❑ Other Agency
Facility Number:
820030
Facility Status: Active
Permit: AWS820030
[] Denied Access
Inppectlon Type:
Compliance Inspection
Inactive Or Closed Date:
Reason for visit:
Routine
County:
Sampson Region:
Fayetteville
Date of visit:
10/2312014 Entry Time: 06:00 pm Exit Time: 7:00
pm Incident #
Farm Name:
CCtTomahawk Farm
Owner Email:
Owner:
Murphy -Brown LLC
Phone:
910-296.1800
Mailing Address:
PO Box 487
Warsaw NC 28398
Physical Address:
3608 CC Rd
Harrells NC 28444
Facility Status:
Compliant ❑
Not Compliant Integrator:
Murphy -Brown LLC
Location of Farm:
Latitude:
34° 43' 31" Longitude:
78' 19' 60"
On the west side of SR 1131 approx. 1 mile north of its intersection with Hwy 41 at Tomahawk, NC.
Question Areas:
Dischrge & Stream Impacts
Waste Col, Stor, & Treat
Waste Application
Records and Documents
Other Issues
Certified Operator: Wayne 0 Sanderson Operator Certification Number: 17903
Secondary OIC(s):
On -Silo Representative(s): Name Title Phone
24 hour contact name Mike Ammons Phone
On -site representative Mike Ammons Phone
Primary Inspector: Robert Marble Phone:
Inspector Signature: Date:
Secondary Inspector(s):
Inspection Summary:
page: 1

Permit: AWS820030 Owner - Facility : Murphy -Brown LLC Facility Number: 820030
Inspection Date: 10/23/14 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations Design Capacity Current promotions
Swine
Swine - Feeder to Finish 12,240
Total Design Capacity: 12,240
Total SSLW: 1,052,400
Waste Structures
Disignaled Observed
Typo Identifier Closed Date Start Date Freeboard Freeboard
Lagoon
page: 2

Permit: AWS820030 Owner -Facility: Murphy -Brown LLC Facility Number: 820030
Inspection Date: 10/23/14 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Discharges $ Stream Impacts
722
No Na Na
1. Is any discharge observed from any part of the operation?
❑
0 ❑
❑
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
❑ ■
❑
b. Did discharge reach Waters of the State? (if yes, notify DWQ)
❑
❑ 0
❑
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑
❑
❑
2. Is there evidence of a past discharge from any part of the operation?
❑
0 ❑
❑
3. Were there any observable adverse impacts or potential adverse impacts to Waters of the
❑
M ❑
❑
State other than from a discharge?
Waste Collection. Storage & Treatment
Yee
No Na No
4. Is storage capacity less than adequate?
❑
❑
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (Led large
❑
� ❑
❑
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a
❑
❑
❑
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
❑
E ❑
❑
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
Yeo No Na No
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ 0 ❑ ❑
maintenance or improvement?
11. Is there evidence of incorrect application?
❑ ❑ ❑
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
❑
PAN?
❑
Is PAN > 10%/10 lbs.?
❑
Total Phosphorus?
❑
Failure to incorporate manurelsludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
page: 3

Permit: AWS820030 Owner -Facility: Murphy -Brown LLC Facility Number: 820030
Inspection Date: 10/23/14 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Waste Application
Yes No No No
Crop Type 1
Coastal Bermuda Grass
(Pasture)
Crop Type 2
Small Grain Overseed
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
cainnoy
Soil Type 2
Leon
Soil Type 3
Tomahawk sand
Soil Type 4
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste
❑
M ❑
❑
Management Plan(CAWMP)?
15, Does the receiving crop and/or land application site need improvement?
❑
❑
❑
16. Did the facility fall to secure and/or operate per the irrigation design or wettable acre
❑
M ❑
❑
determination?
17. Does the facility lack adequate acreage for land application?
❑
ME]
❑
18. Is there a lack of properly operating waste application equipment?
❑
0 ❑
❑
Records and Documents
Yes
No Ns Ne
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑
■ ❑
❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑
of -DE]
If yes, check the appropriate box below.
WUP?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Lease Agreements?
❑
Other?
❑
If Other, please specify
21. Does record keeping need improvement?
❑
❑
❑
If yes, check the appropriate box below.
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
❑
Weather code?
[]
Rainfall?
❑
Stocking?
❑
page: 4

Permit: AWS820030 Owner -Facility: Murphy -Brawn LLC Facility Number:
820030
Inspection Date: 10/23/14 Inpsection Type: Compliance Inspection Reason for Visit:
Routine
Records and Documents
Yes No Na Ne
Crop yields?
❑
120 Minute inspections?
❑
Monthly and 1" Rainfall Inspections
❑
Sludge Survey
❑
22. Did the facility fail to install and maintain a rain gauge?
❑
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
❑
S ❑
❑
appropriate box(es) below:
Failure to complete annual sludge survey
❑
Failure to develop a POA for sludge levels
❑
Non -compliant sludge levels in any lagoon
❑
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑
❑
❑
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
E ❑
❑
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?
❑
N ❑
❑
(i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility?
❑
E ❑
❑
If yes, check the appropriate box below.
Application Field
❑
Lagoon / Storage Pond
❑
Other
❑
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or
❑
0 ❑
❑
CAWM P?
33. Did the Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑
■ ❑
❑
34. Does the facility require a follow-up visit by same agency?
❑
■ ❑
❑
page: 5

Division of Water Resources
❑ Division of Soil and Water Conservation
Other Agency
Facility Number:
820030
Facility Status: Active
permit: AWS820030
[] Denied Access
Inpsectlon Type:
Compliance Inspection
Inactive Or Closed Date:
Reason for Visit:
Routine
County:
Sampson Region:
Fayetteville
Date of Visit:
12118/2013 Entry Time: 02:00 pm Exit Time: 3:00 pm Incident #
Farm Name:
CC/Tomahawk Farm
Owner Email:
Owner:
Murphy -Brown LLC
Phone:
910-296-1800
Mailing Address:
PO Box 487
Warsaw NC 28398
Physical Address:
3608 CC Rd
Harrells NC 28444
Facility Status:
Compliant ❑
Not Compliant Integrator:
Murphy -Brown LLC
Location of Farm:
Latitude:
34' 43' 31" Longitude:
78' 19' 60"
On the west side of SR 1131 approx. 1 mile north of its Intersection with Hwy 41 at Tomahawk,
NC.
Question Areas:
Dischrge & Stream Impacts
Waste Col, Sior, & Treat
Waste Application
Records and Documents
Other Issues
Certified Operator: Wayne O Sanderson Operator Certification Number: 17903
Secondary OIC(s):
On-Slte Representativo(s): Name Title Phone
24 hour contact name Mike Ammons Phone:
On -site representative Mike Ammons Phone:
Primary Inspector: Robert Marble Phone:
Inspector Signature: Date:
Secondary Inspoctor(s):
Inspection Summary
page: 1

Permit: AWS820030 Owner - Facility : Murphy -Brown LLC Facility Number: 820030
Inspection Date: 12/18/13 Inppection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations Design Capacity Current promotions
Swine
Swine - Feeder to Finish
Total Design Capacity:
Total SSLW:
Waste Structures
Disignated Observed
Type Identifier Closed Date start Date Freeboard Freeboard
Lagoon 1
page: 2

Permit: AWS820030 Owner - Facility: Murphy -Brown LLC Facility Number: 820030
Inspection Date: 12/18/13 Inppection Type: Compliance Inspection Reason for Visit: Routine
Discharges &_Stream Impacts
Yea No Na Ne
1. Is any discharge observed from any part of the operation?
❑
0 ❑
❑
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
❑
❑
b. Did discharge reach Waters of the State? (if yes, notify DWQ)
❑
❑ M
[]
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑
❑ M
❑
2. is there evidence of a past discharge from any part of the operation?
❑
M ❑
❑
3. Were there any observable adverse impacts or potential adverse impacts to Waters of the
❑
❑
❑
State other than from a discharge?
Waste Collection. Storage & Treatment
yea
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 (I.ed large
❑
M ❑
❑
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a
❑
0 ❑
❑
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
❑
M ❑
❑
8. Do any of the structures lack adequate markers as required by the permit? (Not applicable
❑
❑
❑
to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑
■ ❑
❑
maintenance or improvement?
Waste Application
Yea No No No
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ 0 Cl ❑
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%110 lbs.?
❑
Total Phosphorus?
[]
Failure to incorporate manure/sludge into bare soil?
[]
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
page: 3

Permit: AWS820030 Owner -Facility : Murphy -Brown LLC Facility Number: 820030
Inspection Date: 12/18/13 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Waste Application Yes No Na No
Crop Type 1 Coastal Bermuda Grass
Crop Type 2
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Soil Type 2
Soil Type 3
Soil Type 4
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste
Management Plan(CAWMP)?
15. Does the receiving crop and/or land application site need improvement?
16, Did the facility fail to secure and/or operate per the irrigation design or wettable acre
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
19, Did the facility fail to have Certificate of Coverage and Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available?
If yes, check the appropriate box below.
WUP?
Checklists?
Design?
Maps?
Lease Agreements?
Other?
If Other, please specify
21. Does record keeping need improvement?
If yes, check the appropriate box below.
Waste Application?
Weekly Freeboard?
Waste Analysis?
Soil analysis?
Waste Transfers?
Weather code?
Rainfall?
(Pasture)
Smalt Grain Oversead
Calnhoy sand, 0 to 5%
slopes
Leon sand, 0 to 2% slopes
Tomahawk sand
❑■❑❑
Yes , No Na No
❑
■ ❑
❑
❑■❑❑
❑■❑❑
page: 4

Permit: AWS820030 Owner - Facility: Murphy -Brown LLC Facility Number:
820030
Inspection Date: 12/18/13 Inpsection Type: Compliance Inspection Reason for Visit:
Routine
Records and Documents
Yee No Na No
Stocking?
❑
Crop yields?
❑
120 Minute inspections?
❑
Monthly and 1" Rainfall Inspections
❑
Sludge Survey
❑
22. Did the facility fail to install and maintain a rain gauge?
❑
E ❑
❑
23. If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment
❑
E ❑
❑
(NPDES only)?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
❑
❑
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?
❑
0 ❑
❑
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
EEI
❑
Other Issues
Yee 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 DWO of emergency situations as required by Permit?
❑
E ❑
❑
(i.e., discharge, freeboard problems, over -application)
31, Do subsurface tile drains exist at the facility?
❑
❑
❑
If yes, check the appropriate box below.
Application Field
❑
Lagoon / Storage Pond
❑
Other
❑
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or
❑
❑
❑
CAWM P?
33, Did the Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑
0 ❑
❑
34. Does the facility require a follow-up visit by same agency?
❑
N ❑
❑
page: 5

`1111i1-
Division of Water Quality
Facility Number F 6 ® 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: 49 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: r r Arrival Time: r30 Departure Time: L:Op County: Region:
Farm Name: � [ �� L605-- Ce--— I -orna�4L- L Wwmwner Email:
Owner Name: _IVIy) h, LLC Phone:
Mailing Address:
Physical Address:
Facility Contact: A Iq 24M mo !4 Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
ELayer
Non -Layer
R
.
Non-L;
Pullets
Poults
Design Current
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Longitude:
Design Current
Cattle Capacity Pop,
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes W No ❑ NA ❑ NE
❑ Yes
❑ No
[RNA
❑ NE
❑ Yes
❑ No
qNA
❑ NE
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 P No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [] Yes Wo ❑ NA ❑ NE
of the State other than from a discharge? 'Tt-''
Page 1 of 3 21412011 Continued

Facili Number: IDate of Inspection: 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 F9 NA ❑ 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 No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) 0
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 0 No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �No ❑ NA ❑ NE
maintenance or improvement? TT
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes P No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑(��Application
fOutside
of Approved Area
12. Crop Type(s): �aas� �Y1 1, �M t `.' ' ".' O W 7
13. Soil Type(s): Cz a
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 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? TT��''
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste TrFfers 0 Weather Code
❑ Rainfall ❑Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 9 No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: 2-- Date of Inspection: 3
L
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
C�)No
[DNA [_] 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.
T
[] Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
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)
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?
❑ Yes
[0 No
❑ NA
❑ NE
❑ Yes
1� No
❑ NA
❑ NE
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Reviewer/Inspector Name: Phone: Ri 0 - q3~ 33CD
g](7
Reviewer/Inspector Signature: Date:
Page 3 of 3 2/4/ 01

Type of Visit: 0 Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: 0 Routine O Complaint O Follow-up 0 Referral O Emergency Q Other 0 Denied Access
Date of Visit: = -u Arrival Time: Departure Time: ro County: S 94DA/ Region:
Farm Name: Cc- 1 Q n4bguj k— Fzw n Owner Email:
Owner Name: 10 wre �,ui � f Phone:
Mailing Address:
Physical Address:
Facility Contact: o4aor r Title: Phone:
li /
Ons€te Representative: Integrator: '' f
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Wet Pouul.p�ltyry//
Layer
INon-Layer
-
D o P,aultr
La ers
Non -La ers
Pullets
Turkeys
Turkey Puuets
Other
Design Current
Capagcityd Pop.
I
W � -
Design Currenw. t
Ca asc 1 Po .
Design Current
Cattle Capacity Pop.
Dairy Cow
airy Calf
D airy Heifer
D Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Wean to Finish
III
Wean to Feeder
Feeder to Finish
Z2
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes P No ❑ NA ❑ NE
❑ Yes [] No 'p NA ❑ NE
❑ Yes ❑ No ra NA ❑ NE
❑ Yes ❑ No
❑ Yes No
❑ Yes No
NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: 2- �O Date of Inspection:
Waste Collection & Treatment
4, is siorage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure l
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in); �V
❑ NA ❑ NE
Cff NA ❑ NE
Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
TT
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
_Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.
❑ PAN ❑ PAN > 10% or 10 ]bs. [] Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind ❑ Application
Outside of Approved Area
�Drift
,
12. Crop Type(s): `'"aka{n�µ�A �S-we�1 Sl+�• V+r2rn QVC�_
_
13. Soil Type(s): PA LeA-, 7�2
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Co No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
IMNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[] Yes}
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[] No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
T No
T
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facility Number: 2.- 3-0 Date of Inspection: ql2qllf
34. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes r] No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No NA ❑ NE
Other Issues
28, Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? []Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes ® No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
[3Application Field ❑ Lagoon/Starage Pond [3Other:
T
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[M No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
M No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[8 No
❑ NA
❑ NE
Comments (referto question #E) Explain any.YES answers.:and/or any additional recommendations or any other�cominents
Use driWings of, facllity'to bettee ex lain situations:(use additional ages.;as necessar )..' M1 t` kf�
Qecayk reLit'4,4 111b11(.
,5,4 V;C' � I/ 2_q11
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: [phone]D
Date: . 4L21(
21412011

Division of Water Quality w/
Facility Number j� 0 Division of Sail and Water Conservation
0 Other Agency
Type of Visit IPCompliance Inspection Q Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint 0 Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 10 Arrival Time: eparture Time: ��' County: SA `. `� TtRegion:
Farm Name: a— dmMV=�
j [ ("' Owner Email:
Owner Name: rt�' °'W n LCC Phone:
Mailing Address:
Physical Address:
Facility Contact: r' `r �"�Y(�is Title:
Onsite Representative:
Certified Operator: _21tolv.-j
Back-up Operator:
Location of Farm:
Swine
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
AA 'f
Z
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other I-
Phone No:
integrator: A&6qpL-P�y &jtn
Operator Certification Number.
Back-up Certification Number:
Latitude: 0 0 = 6 Longitude: = o = ' = «
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
l❑ La er
on La er
Dry Poultry
❑
Layers
❑
Non -Layers
❑
Pullets
❑
Turkeys
❑
TurkeyPoults
❑
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)
Cattle
Design Current
Capacity Population
i
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures.
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [M No ❑ NA ❑ NB
❑ Yes
❑ No
0 NA
❑ NE
❑ Yes
❑ No
I? NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
`?No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes �'Ip No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No/,, NA ❑ NE
Stru ture 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in);
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes N 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)
4. Does any part of the waste management system other than the waste structures require
❑ Yes ANo
❑ 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 [ANo
❑ 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 Windrow Evidence of Wind Drift ❑ Application Outside of Area
eP-!�M
12, Crop type(s) t l'
13. Soil type(s) 56 t I.A ,-rn
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[P No
❑ NA
❑ NE
15, Does the receiving crop and/or land application site need improvement?
❑ Yes
PNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
M No
[INA
❑ NE
17. Does the facility lack adequate acreage for land application'?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[ No
❑ NA
❑ NE
Reviewerllnspector Name 1' `?"'" ��' d u.'' a'- " Phone: U-�Lrj
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? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available'? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑ WUP [3 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 l" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
,E No
[I NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'?
❑ Yes
❑ No
ff] NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[� No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
� No
❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[P No
❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
P No
❑ NA ❑ NE
Page 3 of 3 12128104

Division of Water Quality
Facility Number 30 O Division of Soil and Water Conservation
_ _7rJ ___-- - — Q Other Agency
Type of Visit 0 Compllance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Vlsit O Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of visit: Arrival Time- LL. Departure Time: County: 504014 O Region:
Farm Name: % o/ma hawk= ron Owner Email:
Owner Name:. . ' `u't'ia'�.+l�7'�� t'` U� Phone:
Mailing Address:
Physical Address: ��,I%t 4 IV ,, ,, I
Facility Contact: 1 vvwt s Title: Phone No:
Onsite Representative: N Integrator: AU4404 A4wm
ac
Certified Operator: lazanj sue^ Operator Certification Number: '24 s-� 'b
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = e = 6 = Longitude: = ° = ` 0
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current Design Current
Capacity Population Wct Poultry Capacity Population
❑ La er
❑ Non -Layer
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream ImRacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Daia Calf
❑ Dairy Heifer
❑ Pry —cow
❑ Non -Dairy.
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: all
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
j
❑ Yes RNo ❑ NA ❑ NE
❑ Yes
❑ No
[RNA
❑ NE
❑ Yes
❑ No
[PNA
❑ NE
/�7NA
ElNE
❑ Yes
❑ No
❑ Yes
[PNo
❑ NA
❑ NE
❑ Yes
ONo
❑ NA
❑ NE
12128104 Continued

Facility Number: —
Date of Inspection It 0
Waste Collection & Treatment
4, Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?: IT —
Designed Freeboard (in): _, 1 —
Observed Freeboard (in):-
5. Are there any immediate threats to the inte rity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ,N NA ❑ NE
Structure 5 Structure 6
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes KNo ❑ 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 M No ❑ NA ❑ NE
8, Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes $jNo ❑ 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 IN No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes .P No ❑ NA ❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes P No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
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 El NA ❑NE
No ❑ NA ❑ NE
No ❑NA El NE
10No El NA El NE
& k 19x''" �` ":%:` �., ,.-_.t ea;', �� .. K `,� �C w=,r -.y: "u zE.,:,.. [ „-,,'t.
Comments (refer to quest►��n`#) {Explain a_ny YES'_answersancilnrtany recommendattons orjuny other%comments
7, 3 ,, -r.:. yr' i s L i 9 R �`-
Use drawtngs;;af facility to.better explain�situation.s' (use ailditron'itl pages as necessary}.# Yir:� �f�` ,
.�. x� rt ,jr
Reviewer/inspector Name-�
- -- V f,Pv y - _ T T -`I Phone:
Reviewer/Inspector Signature:
Date: 1111-110,7
12128104 Continuer!

1 _
Facility Number: — Date of Inspection I t [
Required Records & Documents
14. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [5?No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes !� No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �3 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
[9 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
(P No
❑ NA
❑ 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
14 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
1p 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
24.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[� No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[P No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
10 No
❑ NA
❑ NE
12128104

Type of Visit 4P Compliance Inspection U Operation Review U Structure Evaluation U 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: / -'4r F✓ Departure Time: /-� 4 County: 5>�- 2 pSOI1) Region., PRO
Farm Name: CC 1 1rorna_har.J_ 1:'aey" Owner Email:
Owner Name: Mu 1OJ'L�J _9r0 Jr1. U C Phone:
Mailing Address:
Physical Address:
' t
Facility Contact: " �`y a, Title:
Onsite Representative: R i� Qw ► j Srt,`�
Certified Operator: g' C^O"-d 5n'►t1
Phone No:
Integrator:.. 4uY1Q1 UG
Operator Certification Number: a`s6(d
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: 0 0 0 I= Longitude: 00
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Daia Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ' jNo ❑ NA ❑ NE
❑ Yes ❑ No A
❑ NE
L❑ No NA
❑ NE
[]Yes []No [P NA
❑ NE
❑ Yes No ❑ NA
❑ NE
❑ Yes No ❑ NA
❑ NE
Page 1 of 3 12128104 Continued

z
R R
Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
*o
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
MNA ❑ 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
t No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6, Are there structures on -site which are not properly addressed and/or managed
[Dyes
ONo
❑ 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
IP No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
1+No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9, Does any part of the waste management system other than the waste structures require
❑ Yes
[P No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
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
ffAcceptallble Crop Winfdoww�++ ❑ Evidence of Drift ❑ Application Outside of Area
/Wind
12. Crop type(s) Gpac, t ( m Q l]fLcSS QS re1� sue' k a,�-sad
13. Soil type(s) Ca.�ti. al; J Leor% cl.—76
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
&No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
V No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Ej No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
P No
❑ NA ❑ NE
Reviewer/Inspector Name "` ; ''q1- Cb
Reviewer/Inspector Signature: Date: g
Page 2 of 3 12128104 Continuer!

r
Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes RNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes t ``" No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ;5 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
EP 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
19 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
n 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
M No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
03 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
f&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
BNo
❑ 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
[I NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
;gNo
❑ NA
❑ NE
Page 3 of 3 12128104

Faciiiq.Number;
,
0 Dtsislokof WaterQuali
0 Divtsto'n�417Soil and,Wat
0 Other Agcncy<
Conservation
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Vis1t 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: ��.� County: sfA3
Farm Name: i bYhGLV1CtiJ Owner Email:
owner Name! M[ kV14,f ' 6MWVI,� Phnne!
Mailing Address:
Physical Address:
.. t/
Facility Contact: t -5 � _ Title:
Onsite Representative: u
Certified Operator: 1'
Back-up Operator: r�1 'e ry0*l
Location of Farm:
Region:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = 6 = I =1 Longitude: = o ❑ I 1
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish 10 La er
❑ Wean to Feeder ❑ Non -La et
Feeder to Finish �a O
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boats
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharp,es & Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Da Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures.: ©�
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑Yes MNo [I NA El NE
❑ Yes
[:]No
[�NA
❑ NE
❑ Yes
❑ No
RNA
❑ NE
V] NA
❑ NE
❑ Yes
❑ No
❑ Yes
M No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

Facility Number:— Date of Inspection I '
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'?
❑ Yes
t?No
❑ NA
[IN E
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
%0 NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
T to
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
El 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
1�3 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
C0 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 QS No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window \❑ Evidence of Wind Drifi ❑ Application Outside of Area
12. Crop type(s) 9PXM`•'J�RJ—�r` lqu &4 ir,' al"S A
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes J�'No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes fiNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes tgNo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes El No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes Kn No ElNA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
J
T
Reviewerllnspector Name Phone: /U 37-1 a
Reviewer/inspector Signature. Date:
12128101 Continued

Facility Number: — Date of Inspection D
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ 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 Wo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes VgNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[9No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes]
No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
[:]Yes
Q9No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
;9 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes]
No
❑ NA
❑ NE
if yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
tZPNo
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
0 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[)1No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

Type of Visit Compliance Inspection Q Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint Q Follow up . Q Referral O Emergency Q Other ❑ Denied Access
Date of Visit: W
0 Arrival Time: Departure Time: a: County:
Farm Name: ma' Owner Email:
Owner Name: Phone: we
Mailing Address:
Physical Address:
Region: ,
Facility Contact: ,, I, ,, ,_,,f Title: � , �P,h�o,,ne No:
Onsite Representative: 2,kc `ar srn! Integrator: ��pA
Certified Operator: I Operator Certification Number: (�
Back-up Operator: Back-up Certification Number: 1371
Location of Farm: Latitude: = o = 1 = {1 Longitude: = ° 0 6 =
il
Swine
Design C►urrent
Capacity Population Wet Poultry
Design Current Design Current
Capacity Population Cattle Capacity Population
❑ Daia Cow
I ❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑Non -Dairy
'` El Beef Stocker
ElBeef Feeder �j
❑ Beef Brood Cow
Number of Structures:
❑ Wean to Finish
❑ La er
❑ Wean to Feeder
10 Non -Layer I
14 Feeder to Finish
El Farrow to Wean
0
Dr Poultrf ,
❑ La ers
❑ Farrow to Feeder
❑ Farrow to Finish
❑ G
❑ Boars
ers
❑Pullets
Other
❑ Other
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
. Is any discharge observed from any part of the operation?
❑ Yes
QS No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
14 NA
❑ NE
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
❑ Yes
❑ No
[P 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'?
Page I of 3
12128104
Continued

Facility Number. ;1: 3o Date of Inspection iO /
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: 1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No ❑ NA ❑ NE
Oc/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 5tNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [] No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit`? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 10 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) NX—TYU461 0,ra 7.2. t 5 /o4m (?,.,cl,, L
13.
type(s) C� �A '
Soil ees)
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
® No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
® No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
IN No
❑ NA
❑ NE
Comments (refer to'questiun 4) ,>Explain'any YESanswers andlor'any recommendations or any other comments.
Use drawings of facility to better explainsituations. (use additional pages as necessary):
Reviewer/Inspector Name Phonc: ld
Reviewer/Inspector Signature: Date: 151; 3�
rage.4 of j rt11401v4 Lonrinuea

Facility Number: — Date of Inspection 3
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes t No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available'? If yes, check ❑ Yes KNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E] 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 [I 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 ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
91 No
❑ NA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
M No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
®No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
V9 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
Z3 No
❑ NA
❑ NE
Additional Comments and/orDrawings':.:
Page 3 of 3 12128104

Type of Visit ® Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: ®(J Departure Time: TZ' County: 6a! jgsoh Region: ERD
Farm Name: ? e Z / e "A L kj K F VA— Owner Email:
Owner Name: �LTe �-p a! ti �otu--.i f a r�l+rw.s Phone:
Mailing Address: -TJ __ I17Ok
Physical Address:
Facility Contact: !C C ��tv o C ] r.-, .A Title:
Onsite Representative:
Certified Operator: ?, i c_Lcyd cD +H f
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number: (o
Back-up Certification Number:
Latitude: = e = 1 = 11 Longitude: = ° = 6 0 N
Design Current Design . Current -Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
[Feeder to Finish
D
ale)
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
j
Other
❑ Other ,-
_- - _
❑ La er
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turke 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 Heifei
❑ Dry Cow
❑ Non-DaiEX
❑ 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?
❑ Yes GgNO ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
❑ NE
❑ Yes
I No
[to
❑ Yes
❑ NA
ElNE
Yes
0
❑ NA
❑ NE
12128104 Continued

• e
Facility Number: — v
Date of Inspection as = Gtf
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 ��
Structure 3 Structure 4
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 [DNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes [UrNo ❑ NA ❑ NE
❑ Yes allo ❑ 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 ff No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes WNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) /
9. Does any part of the waste management system other than the waste structures require El,-�
Yes [ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes G�No ❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
DNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl [I Application Outside of Area
12.
Crop type(s) IJ er w. u.9 tt ati '� ►-stz,� �r.`�Ll i-j rctl�..
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
[WNo
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
9No
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',[] Yes
[];�No
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
&No
❑ NA [I NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
[]fo
El NA ❑ NE
-omments (refer t�ojy uestion?#.): Explain any�YES tlnswer& sndlor any Ceconlmendatlons or any other comment9.
Use drawEngs of facility to4be,tter explain situahoits, {use�additianal pages as necessary):
.ems LYiSF:•.i�..�'�..-4'k3zF.Y�i.t. . `��!'S ii
Reviewer/inspector Name F— �"
Reviewer/Inspector Signature:
t ��,r.- ' Phone:
Date: -5-- 6 G — os�
12128104 Continued

Facility Number: ?2. -3() Date of Inspection ja v
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes D<o ❑ NA ❑ NE
20, Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes M-Ko ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement'? if yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Wa ❑ V1tec141-Ffeebeasd ❑ Vvzv�nalysis ❑ Se+i-t'rrtatysls ❑ Waste Transfers ❑ Annual
❑ I' ❑ Ste} ❑ C-Fep-� ❑ ❑ ns ❑ WwMw-Gede
22, Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25, Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
f yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (icI discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Additional Comments`and/or,Drawings ;;
❑ Yes [ti]'No ❑ NA ❑ NE
❑ Yes
["No
❑ NA
❑ NE
❑ Yes
M No
❑ NA
❑ NE
❑ Yes
D-fqo
❑ NA
❑ NE
❑ Yes
3"No
❑ NA
❑ NE
❑ Yes
Egf�o
❑ NA
❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes Q'No ❑ NA ❑ NE
❑ Yes D No ❑ NA ❑ NE
❑ Yes Cg'No ❑ NA ❑ NE
❑ Yes
E,.�, No
❑ NA
[I NE
El Yes
My//o
❑ NA
❑ NE
12128104

(Type of Visit GrCompliance Inspection O Operation Review p Lagoon Evaluation
Reason for Visit 0 Routine O Complaint O Follow up O Emergency Notification O Other CI Denied Access
Facility Number
Elate of Visit: fi Z 0 Time:
2 30
Not Operational 0 Below Threshold
© Permitted [3 Certified 0 Conditionally Certified 13 Registered Date Last Operated or Above Threshold : .........................
Farm Name: .............. !;,� lC:.,�....TOv�&a0. % et W k......�a rv.!�............. County:................... .4Y4...SQ1!4...........................
Owner Name; ................LY`m I.C. � `Y........k? rf?..�? �....................................... P�hpone No:.......... g � 0........,�r �.Q...... ,�t.11.1....................
MailingAddress: .............F:.�.:......&Q ........!,1F.................................................... ......1!�.4., -... ►..�!............N. .................. .. �?. .$.
Facility Contact. ......... Z � ire- ..4......
+ .1 ' 4' .... Title; ................................................................ Phone No: ...... �.�...... k?.- Z fi
Onsite Representative: ....... 15..,%�rl ..i A. ......� r.'..4.�................................ Integrator:................ .V .rJ�.�! ....'......4�r�.Jl!. �.
Certified Operator:.......... ...... 71I. AAA1 ......................... I..... Operator Certification Number: ........ 4.3.ks�......
Location of Farm:
i
�I
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• ��;�
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes JK No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 2 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes MNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes +RNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .................. I................ ................ 21..........................................................................................................................................................
Freeboard (inches): 3 �_
12112103 Continued

Facility Number:
0
Date of Inspection I
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ FAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type ger-v►%voEa , Svrtau a r-a i V%.
❑ Yes KNo
❑ Yes VNo
❑ Yes MrNo
❑ Yes 4 No
❑ Yes `7No
❑ Yes 5No
[:]Yes 'allo
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes No
b) Does the facility need a wettable acre determination? ❑ Yes 5,No
c) This facility is pended for a wettable acre determination? ❑ Yes 29.No
15. Does the receiving crop need improvement? ❑ Yes ;K No
16. Is there a lack of adequate waste application equipment? ❑ Yes ANo
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 R No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes No
Air Quality representative immediately.
r...•1,t:�ltt:i41i4i.-, ^t�➢x'^`�=4.:°'�tn; .`!!.�. .i�ii� ..u. 'm71" !:�w�:l, r.;� -�I.t c m. rlxlu,,�!a..r....un«it�_!�.m>ia t<<. »:rt>±n.d��:>:•�'}nlnt�..�€a: a,�n,r. u�,�. ,,i.:-.:.,�u➢!w ry r„i�' i :a,- ' ti' 'i
Continents'i(refer W;questton'.�tj:Ir[;Expiam aay, YES'nns�vers gnd/or any recommendations;orany utbeac commenW
,I
"m
4rJ.t,.,�,yr,�n-rtp�ea€i� F:;��..:� �, sw.,°>.,u➢I�.�ulliw.+:U.<, u r. ,1:'1:.�;,3-....�ridi�r i �i.�n, u,i ,c .�r.�e::x. �ci��:�� c- ,..<.3.,,urw,._�,r:�sa�n an.�is,..:-a.....E»,.:....;..�x,.,..-..€..,.�,:>€:I.,>....�...I.cr4a €� i,;�:�:#-:
Use drawtn of faciii tobetter, Isla sttnsdons use addYtiona! a es€as'necessa I,:=.
I;sx, h'� P, g. ry} Field Copy ❑ Final Notes u4h
i -➢.�:
�h s !!! i ;�iail JJ ii -- 1? I. :r➢��ttr` {,'�€€� : €�I i �'i i:3 i�:i.l �{ 1 II,}i>.. F „ya _�, -_ -.j�, `7 ''.�'^�}�,i`'.!.�"���{.n a f i. :F' �. l�.- }. •y�..' .3 !?{:,
�.3 NTs..lis4Lr�i? ii�;".-i�E�1: N�!:( �tiE_,.#�nh;ri�ui'1.➢�➢Iilii:� r'�t�3iL _.nlr,ilillF-63'1n1F�h'N°r'1�➢b `}:a,3-EyRI�➢LKI�Nf° xisl.!➢�f!`al,,(},; !SIB ---_. �.'...'IIfTi. an"".i:�iA'RiV."'F �3"lia•,i!'njl*i "E➢:aix.'ka�'6:
S��eo[uled -I-o CU+ wv_e S- ar-Vur� ia�aov5
15 . SP!'��a well ow
(o. I A �ro cess o f cAo s+ La_t&D-v.
� i€
1151 i,o ,l jT Reviewer/Inspector Name `i! � '; ii ; rrv,Y l l r
S >G►y
Reviewer/Inspector Signature: Date:-*Z2_ZCy
12112103 C Continued

Facilfty Number: 8 Z — 3p Date of Inspection 0 /
Required
Records & Documents
21.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
;&No
22.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUV, checklisvKdesigd fmapsl-fc.)
❑ Yes
®,No
23.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
®,No
❑ Waste Application❑ Freeboar&'*j❑ Waste Analysii,"'O Soil Samplingo"�
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
X No
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
0 No
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
En No
28.
Does facility require a follow-up visit by same agency?
❑ Yes
XLNo
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
4No
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
RYes
❑ 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
® No
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
[NNo
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ®,No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes CH No
❑ Stocking For ❑ Crop Yield Fornl00'❑ Rainfaho"[] Inspection After V Ralrroo'
❑ 120 Minute Inspectiors"❑ Annual Certification Forrg/
12112103