820146_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

. NNS avlyf- 70
Division of Water Resources
❑ Division of Soil and Water Conservation
❑ Other Agency
Facility Number:
820146 Facility Status:
Inpsection Type:
Compliance Inspection
Reason for Visit:
Routine
Date of Vistt:
09/20/2017 EntryTime: 10:00 am
Farm Name:
Riverfront #1 & 2
Owner.
Quarter M Ranch Inc
Malling Address:
PO Box 1139
Physical Address:
9419 Tomahawk Hwy
Active Permit: AWS820146 ❑ Denied Access
Inactive Or Closed Date:
Exit Time
County: Sampson Region: Fayetteville
10:45 am Incident #
Owner Email:
Phone: [phone]
Wallace NC 294661139
Harrells NC 28444
Facility Status: Compliant ❑ Not Compliant Integrator. Murphy -Brown LLC
Location of Farm: Latitude: 34° 41' 31" Longitude: 78" 20' 18"
On the south side of Hwy 41 approx. 1 mile east of SR 1119, east of Tomahawk, NC.Farm # 2780-2785.
Question Areas:
Dischrge & Stream Impacts Waste Col, Stor, & Treat Waste Application
Records and Documents Other Issues
Certified Operator: Douglas Stephan Atkins Operator Certification Number: 985738
Secondary OIC(s):
On -Site Representadve(s): Name Title Phone
24 hour contact name Douglas Atkins Phone
On -site representative Douglas Atkins Phone
Primary Inspector: Bill Dunlap Phone:
inspector Signature: Date:
Secondary Inspector(s)-
inspection Summary:
Calibration 5/15/2017
Sludge Survey #1 N-5.1, 0-10 53%, #2 N-5.5, 0-4.7 41 %
Please remove old plastic wrapped hay/balage. Soil samples are for Com, crop in Bermuda.
#7 Improve vegetative cover on lagoon banks to prevent erosion.
page: 1

rM
Permit: AWS820146 Owner - Facility : Quarter M Ranch Inc Facility Number. 820146
Inspection Date: 09/20/17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations Design Capacity Current promotions
Swine
■ Swine - Farrow to Wean
7,000
7,000
Swine - Feeder to Finish
2,000
2,000
Swine - Wean to Feeder
800
800
Total Design Capacity: 9,800
Total SSLW: 3,325,000
Waste Structures
Dlsignated Observed
Type Identifier Closed Date Start Date Freeboard Freeboard
Lagoon
1
Lagoon
2
Lagoon
RIVERFRONT 1
20.00
40.00
Lagoon
RIVERFRONT2
20.00
32.00
page: 2

Permit: AWS820146 Owner - Facility : Quarter M Ranch Inc Facility Number. 820146
Inspection Date: 09/20/17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Discharges $ Stream Impacts
Yes
No Na No
1. Is any discharge observed from any part of the operation?
❑
0 ❑
❑
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
M ❑
❑
b. Did discharge reach Waters of the State? (if yes, notify DWQ)
❑
M Cl
❑
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑
❑
❑
2. Is there evidence of a past discharge from any part of the operation?
❑
❑
❑
3. Were there any observable adverse impacts or potential adverse impacts to Waters of the
❑
0 ❑
❑
State other than from a discharge?
Waste Collection, Storage S Treatment
Yes
No No Ne
4. Is storage capacity less than adequate?
❑
M ❑
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (Le./ large
❑
0 ❑
❑
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a
❑E
❑
❑
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
1111
❑
8. Do any of the structures lack adequate markers as required by the permit? (Not applicable
❑
■ ❑
❑
to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑
M ❑
❑
maintenance or improvement?
Waste Application
)Na No Na No
10. Are there any required buffers, setbacks, or compliance altematives 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 > 100/6/10 lbs.?
❑
Total Phosphorus?
❑
Failure to incorporate manure/sludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
page: 3

I
Permit: AWS820146 Owner - Facility : Quarter M Ranch Inc Facility Number: 820146
Inspection Date: 09/20/17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Waste Application Yes No Na No
Crop Type 1 Coastal Bermuda Grass
(Hay)
Crop Type 2 coastal Bermuda Grass w/
Rye Overseed
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Wagram
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?
❑
0 ❑
❑
Records and Documents
Yes No Na No
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑
❑ ❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑
❑ ❑
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

k
Permit: AWS820146 Owner - Facility: Quarter M Ranch Inc Facility Number. 820146
Inspection Date: 09/20/17 lnpsection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents
Yea 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?
❑
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
❑
❑
❑
appropriate box(es) below:
Failure to complete annual sludge survey
❑
Failure to develop a POA for sludge levels
❑
Non -compliant sludge levels in any lagoon
❑
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑
❑
❑
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
0 ❑
❑
Other Issues
Yes No Na Ne
28. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑
■ ❑
❑
and report mortality rates that exceed normal rates?
29, At the time of the inspection did the facility pose an odor or air quality concem? If yes,
❑
0 ❑
❑
contact a regional Air Quality representative immediately.
30. Did the facility fail to notify regional DWQ of emergency situations as required by Permit?
❑
❑
❑
(i.e_, discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility?
❑
0 ❑
❑
If yes, check the appropriate box below.
Application Field
❑
Lagoon l 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 Reviewerllnspector fail to discuss reviewlnspection with on -site representative?
❑
❑
❑
34. Does the facility require a follow-up visit by same agency?
❑
❑
❑
page: 5

type of visit: t=ruompnance Inspection v vperation mevlew U Structure Evaluation v t eennlcal Assistance
Reason for Visit: routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: c Departure Time: County:
Farm Name: �E C(7r's,Ni_=jr 0 Owner Email:
Owner Name: 6 4"O"4"4g 94 Phone:
Mailing Address:
Physical Address:
Facility Contact: Do
Onsite Representative:
Certified Operator:
Back-up Operator:
Ll
C t. Title:
Integrator:
Phone:
k(3 S
Region:rQ 1D
Certification Number: e,5IS
ff
Certification Number:
1 ne�tinn of ]Wevm• l.atitnrio• T.nnoitaldp-
Discharees and Stream Impacts
1. Is any discharge observed from any pan of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes. notify DWR)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑� lGo ❑ NA ❑ NE
❑ Yes
0 No
�A
❑ NE
❑ Yes
[] No
E�J'NA
❑ N E
❑ Yes [] No
❑ Yes O�4o
❑ Yes E�No
E�fNA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

[Facility Number: - 114 jDate of Inspection: t1 J�/8tJ
T
Waste Collection & Treatment
4rls storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes B-N-5--F] NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No Q� ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): X 5
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 EEI'No ❑ NA ❑ NE
❑ Yes ENo ❑ NA ❑ NE
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? ff Yes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes [B 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 Auolieatiorl
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 E3`go ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): w al
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Ca< ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [] Yes to ❑ 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
ETNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[�o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�-,�
L.Z o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
<o
❑ 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 c ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Fj 1Vo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - 7117 jDate of Inspection: 10 r
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ®`No ❑ NA [3 NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes [3" qo ❑ 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
FZrlq'o
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
Ej- o
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[3'go—
❑ 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
f yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
Q'1Go
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility9 If yes, check the appropriate box below.
❑ Yes
E31Jo
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[]'lqo
❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
dNo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[ o
❑ NA ❑ NE
kC_K0C'A_ 4 fict-ty
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
TIMM
Phone: q33 - 3 33 y
Date: C) Ay [ �
21412015

tins 7 b
Type of Visit: QCom��pliance Inspection U Operation Review O Structure Evaluation p Technical Assistance
Reason for Visit: Gdioutine O Complaint O Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit: ! Arrival Timer Departure Time: County:
Farm Name: bA q &4'� Owner Email:
Owner Nam . R �) W "4 /1±2:: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: I 1
Back-up Operator:
Title:
Phone:
Region
Integrator: a1 S
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Impacts
I _ Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
[]Yes 01-ONo ❑ NA ❑ NE
[]Yes ['No ❑ NA ❑ NE
❑ Yes E' No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes [;kNo DNA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes E2;No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes QMo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Contdnued

Facility Number: -t Date of Inspection: 0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [D'T-o ' ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [:]Yes [3-N6- ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 7/
5. Are there any immediate threats to the integrity of any of the structures observed? [-]Yes Ff No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ❑ No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? []Yes [t]No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [l"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 (NNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [-]Yes [7No ❑ NA ❑ NE
maintenance or improvement? /
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑/No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): _ - "1C' 0't"A S' C .2 - -
13. Soil Type(s):
l4. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
C] No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
MYes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[] Yes
�o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
['_'No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
o
❑ NA
❑ NE
Required Records & Documents
19_ Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
dNo
❑ NA
❑ NE
20_ Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
[2"&o
❑ 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 0 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 eNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0"No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: - Date of inspection: f!U
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
g]-Ko
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
Yes
❑ No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
[:]Yes
EYIN'"o
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
E]"No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes
[fjlNo
❑ 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
dNo
❑ 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
0No
❑ 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
E No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[3�No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
f o
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
gNo
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and1. & any additional recommendations or any other�cou me �ts �� l
Use drawings of facility to better explain situations (use add bonalpazes as
1 b-1 0 —1S
3, z
N �" —z
1'�()'7' 1-04
1b(e-e'4"q1
� l s (IL rVoL-t OW 4y -
jfU'/ ( C7Q'
�k6vu 4kK- � y
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: `kQ J j j J W
Date: W d d j J
21412014

type or visit: ur t-ompuance inspection v operation review u structure r.vatuation u iecnmcai Assistance
Reason for Visit: (Y Routine 0 Complaint 0 Follow-up O Referral O Emergency 0 Other 0 Denied Access _j
Date of Visit: Arrival Time: y Departure Tlme: County:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
ox �_*f Title:
Onsite Representative:
Certified Operator:
Phone:
Region: [rF. fl
Integrator: 166
Certification Number: lt5 73
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Finish
Wet Poultry
La er
Design Current
Capacity Pog.
El
Design Current
Cattle Capacity Pop.
Dai Cow
FEffanto
to Feeder o
D
Non -La er
Dai Calf
eeder to Finish a VV
o
D P,oaltr
Layers
Design Current
Ca aci 1?0 -
Dai Heifer
Cow
Farrow to Wean p 09
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
HPullets
Non -Layers
Beef Feeder
Boars
Beef Brood Cow
Other
Other
L
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes D-Ko ❑ NA ❑ NE
❑ Yes
❑ No
®NA
❑ NE
❑ Yes
❑ No
❑, A
❑ NE
❑ Yes
❑ No
C] NA
❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes
Cj"No
❑ NA
❑ NE
Page I of 3
21412014 Continued

Fa 'li Number: - Date of Ins ection: z,
,ZLWaste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes D44tr`❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
❑ Yes [-]No []9KA ❑ NE
Structure 5 Structure 6
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [3-tqo- ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
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?
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ Yes �o ❑ NA ❑ NE
9. Does any part of the waste management system other than the waste structures require ❑ Yes [3 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
No
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes [T
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ETNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window❑- Evidence of Wind Drift
❑ Application Outside of Approved Area
+
12. Crop Type(s): - ev w-ai
13. Soil Type(s): _ c ✓4
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes [ttQb
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[:]Yes I_ J o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑-Go ❑ NA ❑ NE
acres determination?
IT Does the facility lack adequate acreage for land application'? ❑ Yes [Rlqo ❑ NA ❑ NE
18_ Is there a lack of properly operating waste application equipment? [:]Yes Vo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
ED No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[D'fVo
❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
�o
❑ NA ❑ NE
❑ Waste Application ❑ Weekiy Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l ° Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
E No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[-]Yes
No
❑ NA ❑ NE
Page 2 of 3
21412014 Continued

IFacqity Number: jDate of Inspection: �
.24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes [�'iVo
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check [-]Yes [P-No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes Lg 1f o
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes UKO
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
�] NA ❑ NE
[] NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
❑ Yes El"'No ❑ NA ❑ NE
❑ Yes
❑ Yes �70
[:]Yes
❑ NA FINE
❑ NA ❑ NE
❑ NA ❑ NE
-1 �
Comments (refer to question #): Explain any YES answers and/or any additional:.recommendations or�any-other comments.
Use drawings of facility to better explain situations (use additional pagesas. necessary).
iMp40.1
'2-
�ai
Mo cA"- o Ne, s M1p S
r
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
1-11
Phone: '163 33 J Y
Date:
21412074

Type of Visit: 0 Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 46 Routine 0 Complaint O Follow-up 0 Referral O Emergency O Other O Denied Access
Date of Visit: t+ i3 IL Arrival Time: 2 ' Departure Time: p ;3O County:'C'"r'OA"Region:�
� j '
Farm Name: f91 V Pi�e.V— / � .:2 Owner Email:
Owner Name: Q,r4e�— '' r ►�`"r'� ,e r Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
N
Phone: %
Integrator:
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
F
Design
Current.
Design
Current.
FIRE
ultry
Capacity
Pop.
Cattle C
Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
$'
Non -La er
Dai Calf
Feeder to Finish
III
Da Heifer
Farrow to Wean
'10010
Design
Current
Dry Cow
Farrow to Feeder D . PouJtnY Ca aci Pori-
Non -Dairy
Farrow to Finish
24Q50
U00
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Pullets
Beef Brood Cow
Boars
Turkeys
Othe
urkey Poults
Other
Other
Discharges and Stream Impacts
I _ is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
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)?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
❑ No
® NA
[] NE
❑ Yes
[:]No
[5 NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [:]No
❑ Yes allo
❑ Yes P No
�+]NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Faciii Number: jDateof Inspection: if
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
NA
❑ NE
Structure i Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
T
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste ApDlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes T No ❑ NA ❑ NE
maintenance or improvement?
I I. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [;g No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [] PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): C . ub
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ® No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [� No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [� No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
P No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
1P No
TT
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Ep No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
M No
❑ NA
❑ NE
the appropriate box.
❑WUP El Checklists ❑ Design ❑ Maps [—]Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
M 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
Tn
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
`�'
❑ NA ❑ NE
Page 2 of 3
21412011 Continued

Facility Number: -7 jDate of lns ection: 3 l2
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes F 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.
[D 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 fast 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 ❑ Yes No ❑ NA ❑ NE
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? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
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?
ents (refer to question # ): E
awines of facility to better t
ReviewerAnspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
any YES answers; and/or any additional
situations fuse additional naves as neces
[:]Yes No
[:]Yes No
[:]Yes 00 No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone:0' -3
Date: i3 2
21412011

Type of Visit: 4P Compliance Inspection U Operation Review U Structure Evaluation Q Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Fallow -up 0 Referral 0 Emergency 0 Other 0}.Dennied Access
Date of Visit: l7 Arrival Time: Departure Time: CI�Si County:TX�' Region:
eRt Farm Name: f v`�''►�C� 1 S �— Owner Email:
Owner Name: Quad g c M Ck 4:T,L , Phone:
Mailing Address: 11
Physical Address:
Facility Contact: "('s Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
�r
to
Phone:
Integrator: `n�!
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Finish
Feeder
o Finish
o Wean
o Feeder
o Finish
E
Other
Other
Design Cui rent.`
pacify Pop , Wet Poultry
+ ._ La er
Non-Laer
r;'' D z P,nult,
La ers
Non -La ers
Pullets
-..' , .. Turkeys
TurkeyPoults
Other
Design
Capacity
Design
Ca aci
Current
Pop.
Design
Cattle Capacity
Dai Cow
Current
Pop.
Dai Calf
Da' Heifer
Current
Pao ,
D Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
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)?
❑Yes PNo ❑NA ❑NE
[:]Yes [-]No
[:]Yes [-]No
NA ❑ NE
NA ❑ 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 ® No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes �] No ❑ NA ❑ NE
of the State other than from a discharge? T
Page I of 3 21412011 Continued

Facility Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No D NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No 91
NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: A
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in): ✓J a
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes IS No ❑ NA ❑ NE
(i.e., large trees. severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement'? D Yes (�j No
❑ NA
ONE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes TTM No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) T
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
[DNA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window Evidence of Win rift ❑/'Application Outside of Approved Area
� "I �S
12. Crop Type(s): �3 �l �"
13. Soil Type(s): CaB
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 TT 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
`�i No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
® No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes T No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey O Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal'?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes
T No
❑ NA
❑ NE
❑ Yes
Q§ No
❑ NA
❑ NE
❑ Yes No
❑ Yes No
❑ Yes No
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency'? ❑ Yes
PNo
No
❑ NA ❑ NE
[] NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any°additional recommends tions,orFanv o her comments. -I
Use dra`►•inas of facility to better explain situations [use additional uaQes as necessarsJ:
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone: 9�70
Date:
Loli2�/
21412011

V
Type of Visit EMompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit (D4tbutine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: �7 rrival Time: / D Departure Time: Q County: Region: �� V
Farm Name: Owner Email:
Owner Name: U (,{ R r+r-r %ri _ S,I e­ Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: ZE�✓. /T1 �-� Phone
No:
107
Onsite Representative: t Integrator:/l u ✓� •+�
Certified Operator: 2&u. 4Z4_-�ie + s — Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 0 4 = Ii Longitude: = ° 0 I = u
Design Current
Design Current
Design Current
Swine
city2nopulation
Wet Poultry Capacity Population
Cattle Capacitya Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
d 1 AIT 0
1 10 Non -Layer I
❑ Dairy Calf
❑ Feeder to Finish I
I
❑ Dairy Heifer
❑ Farrow to Wean
00 r,>0
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
fiZiCOD
❑ Layers
El Beef Stocker
❑ Gilts
Non -Layers ers
❑ Beef Feeder
❑ Boars
❑ Pullets
ElBeef Brood Cowl
El Turkeys
Other
❑ Other
El Turkey Pouits
El Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at; ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes. notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes RNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
0-No
❑ NA
❑ NE
Page 1 of 3
12128104 Continued

Facility Number: -N4-
Date of Inspection
* Waste Collection & Treatment
4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: :Z .., �ei' / F, ' ` ey ;?—
Spillway?, -
Designed Freeboard (in):Z
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes L-No
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
❑NA ❑NE
Structure 6
❑ Yes ®,No ❑ NA ❑ NE
❑ Yes Q 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 KNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes D4 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 S No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [&No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ®,No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus [:]Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ElApplication Outside of Area
12. Crop type(s) - /QyT —4V- ,/
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CA W M P? ❑ Yes [RNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes Q.No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes ® No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [9 No ❑ NA ❑ NE
s_ M e
°Comments (refer to `question #): Explain any YES answers and/or any recommendations or any other comments
[Tse wings, of facility to better explain situations use'addttional a es as,necessa
Reviewer/Ins ector Name
P Phone: 4/li-t/33-33
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 CgNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Ycs Z.No ❑ NA ❑ NE
the appropriate box. ❑ W­Up ❑ Checklists ❑ Design ❑ Maps
p El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes JZ[ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[.No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
5. No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[KNo
❑ 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
[BNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ZLNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
QNo
❑ 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
JRNo
❑ 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
UNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
15No
❑ NA
❑ NE
Additional Comments and/or Drawings ",
Page 3 of 3 12129104
Page 3 of 3 12129104

13 I MS av1 q r I s10
Type of Visit 1'& Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 9 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: B, 3 o AlDeparture Time: f (Gn(3 County: Region:
Farm Name: 1 V� �� 4 Owner Email:
Owner Name: �11I[! &Ch Phone:
Mailing Address:
Physical Address: Facility Contact: t �^1 1 J Un+oi __ Title: Phone No:
Onsite Representative: ,?�i is 1�ti integrator: Hyehf Rip LiYv_j_x iri'►+j�l�^
Certified Operator: Da k-Ifthf Operator Certification Number: AA 99'7.39
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = e = 1 =46 Longitude: = ° = I = u
Design Current Design Current Design Current
Swine Capacity Eopulation Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
Wean to Feeder
❑ Non -La er
E�]]J❑
Dai Calf
❑ Feeder to Finish
Farrow to Wean
❑ Farrow to Feeder
Poultry
`7 DtrPLayers
❑ Dai Heifer
❑ Cow
❑ Non -Dairy
a Farrow to Finish
❑ Beef Stocker
❑Gilts
rs
❑ Beef Feeder
❑ Boars
❑ Beef Brood Cow
❑ Turkeys
Other El Turkey Pouets
❑ Other ❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑Yes ®No ❑NA El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[NNo
❑ NA
❑ NE
❑ Yes
[9No
❑ NA
❑ NE
12128104 Continued

I
Facility Number: a, -- 1 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes '�j No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): ap _ CID
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes allo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ® No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes JR 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 E;allo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) /rnr�((;I &Y 01-MAW -
13_ Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
® No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes
C❑-No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
to No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
®"No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
'® No
❑ NA
❑ NE
Comments (referito question #}. Explain any YES -answers -and/or any recommendations: any other comme tts.
Use drawmgs of facility to`better explain situations {use addittdual pages as necessary]"��
ector Name ` .,` .NNt ` °
p �`f �+ 1d 43)J3W X- 311
Reviewer/Ins Phone:
Reviewer/Inspector Signature: _. Date: 5?d f f ,--)(' .l

Facility Number:003 — j 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 El Checklists ❑Design El maps El other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 9 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
91 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
© No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
93-No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did ReviewerfInspector fail to discuss review/inspection with an on -site representative?
❑ Yes
B No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
RNo
❑ NA
❑ NE
Additional Comments and/or DrawingZI
s:
&SO,t"), it ���{ U114 i"e ON, SO"e_ fGrLS 6i. II`Me (',Ifrl►�� �cl�t`uC�
check A eO-so j I Gh+ ls- Ohd 010kle Q dect J-(O-) -flwn,
1212&04

Y Facility NoY(C-nc
Farm Name �f�,B`tC<prr� �� Date C(f 1 j tog
Permit `� OIC A4Wh aa6 NPDES (Rainbreaker PLAT Annual Cert )
ak Uv(- SAP
Po . -Type Design Current
J
`57 1,-XX3
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
Slud a De th (ft) & %
p
3,9
Liquid Trt. Zone ft
s(p
Calibration Date
Design Width
Soil Test Date Wettable Acres
pH Fields WUP
Lime Needed Weekly Freeboard ve-
Lime Applied Rainfall >1"
Cu . ---' Zn 1 in Inspections
Needs P 120 min Inspections
uroo Yceia
Waste Analysis Date
- 60 Da
+ 60 Da
N Amt Ib11000 Gal
H
Weather Codes
Transfer Sheets
RAIN GAUGE
ead box r incinerator
Morta i y Records
Pull/Field
Soil
Crop
RYE
PAN
Window
Max Rate
Max Amt
-Se
0,
+ •Q
Verify PHONE NUMBERS and affiliations
Date last WUP FRO,�IaLJCO 61- 3bj)O Date last WUP at farm
FRO or Farm Records 1JF= FPQ "FfO FOA)
Lagoon #�--
Top Dike Qa'0 Qy`S
Stop Pump sn� (?I,
Start Pump N,3-r R14
Approx. Conversion- Cu-I 3000= 108 lblac; Zn-I 3000= 213 Iblac
App. Hardware �-- ie�j

V
Type of Visit m§kCompliance inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit o42outine 0 Complaint 0 Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit:WlZql 05 Arrival Time: Departure Time: County: Region:.pro
Farm Name: f ��Q Owner Email:
]
Owner Name: V * Phone:
Mailing Address:
Physical Address:
Facility Contact: A -0--- tO'1 Title:
Onsite Representative: AT
Certified Operator: POtq r�J+
Back-up Operator:
Phone No:
Integrator•
Operator Certification Number: 6.1 R$S73ff
Back-up Certification Number:
Location of Farm: Latitude: 0 e ❑ + =1 1+ Longitude: 0 ° ❑ ' E__1 W
DFsi-n
Swede ..4. Capacity IPopu ur!rahoy WetP�ltry#Capacity Population `` Cattle Capag ty pops rent
,e
W
lation
❑ Wean to Finish ❑ La er ❑ Dairy Cow
Wean to Feeder $Lb ❑Non -La er ❑ Dairy Calf
Feeder to Finish a000 "' _$ + i `' ' ❑ Dairy Heifer
Farrow to Wean _761V'" "' El Dry Cow
- Dry�Paul�tr�y
El Farrow to Feeder ❑ Non -Dairy
❑ Farrow to Finish ❑ La ers
❑ Beef Stocker
❑ Gilts ❑Non -Layers ❑ Beef Feeder
❑ Boars El Pullets ❑ Beef Brood Co
+.: ❑Turke s
OtherE.
❑Turke Poults
❑ Other f ❑ Other Number of Structures:
Discharaes & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
ER No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DI
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
CffNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
93�No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: c3 — )y Date of Inspection FWV4
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
E"No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
P No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: PiVrbMf 1 Riy&9MI
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
JRNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
154 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
ERNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
J 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
[XNo ❑ NA ❑ NE
maintenance or improvement?
Waste ApRlication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
A
,��CNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Q�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 ofnAcceptable
�Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) (�2 'R
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes C No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [�jNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes C3 No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
;Yes
❑ No
❑ NA
❑ NE
❑ Yes
[$No
❑ NA
❑ NE
�.. �." Y b MF . u tY _ mendat�onsatty outer
iCommen9Rrefer t6iquestton�#) aplain au �YES,answers and/or:an recam comments.
Use drawingslof facm ' toxbetter explainsttstauons x(uW addittotlal^"pages as�necessary)
4
Reviewer/Inspector Name E�OI; ►I S<f vE� _ Phone: 1d 43.3-3M a
Reviewer/Inspector Signature: Date: d 0oa
peon 7 of 3 U 12128104 Continued

Facility Number: $a — f y Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes
MNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes
[RNo
❑ NA
❑ NE
the appropirate box.
❑ WUP [I Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes
C No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑
Weather
Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes
ONo
❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El Yes ❑ No DNA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
P9 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
BNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
R5 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
[-NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
l5a"No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ffNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[$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
allo
❑ 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
5?No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
RNo
❑ NA
❑ NE
— In 1r___r — -.. —_.�— 1lVVfv rf
R-f(ds- will Iim
qq Ofa of p-tu `his
m� )1, `�r�ff(a-� act vtlj wea-f-he,
a , Pike coifFo��irnadr'�� rna����1�
or a d �� s ra per, R+A) vafWj w f-e a � i h� t * nn��a 1 its
d � � y 9
all Fos*ctor ypelib
VVRI [ rnk+ ,r r°cas- oh Cv� fi'
Page 3 of 3 12128104

i
0 wo ige-- &-Pr-�M rvn o
Facility No. $a Farm Name
Permit �_ COC
Pop.Type Design Current
b 2k.
v fu -A S
3inbreaker PLAT
of o-Pvol
Annual Cert )
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
a
30 3S
Observed freeboard in
Sludge Survey Date Perm Liquid ft
111110 Sludge Depth ft
a.
(r
'1rxr�RG �0.�01{I']
Calibration Date
Design Width
Actual Width
`.�Oif . i✓D�dto-f �B/'fvs.,-�,p 5� rho �n6---
Soil Test Date Crop Yield a0Dir10
pH Fields Wettable Acres ✓
Lime Needed ALF� 0,Q-1p/& WUP /
Lime Applied RAIN GAUGE
Cu �Z_ Zn Weekly Freeboard
Needs P tjo Rainfall >1"
1 in Inspections
120 min Inspections
Weather Codes
Transfer Sheets
Date of last Waste Plan in FRO Date of last Waste Plan at farm 3 - Aoo. Hardware A -A -elf
Pull/Field
Soil
Cro
RYE
PAN
Window
n►
�i
k!I'th-
phone numbers and affiliations
a`
5304 ga3T�SCIa.sr
TMsI;�� ups l Y
r t4 1pa2 -ReV, 0y o rhb�
-� bo-ecrj &� f�F*01

_ PN)o -Q rPd-b'0p�
�c
5* I rb_ Sqj SC I L,
,oj8c�-
'AQ/ (I �—c.a_s-11
95-MF
I If

I
WDivision of Water Quality �+
Facility Number L/ 0 Division of Soil and Water Conservation
- 0 Other Agency
Type of Visit O'Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: �� (� Departure Time:/0 a7� County: Region:`
J�
Farm Name: �- Owner Email:
Owner Name:6? / C. Phone:
Mailing Address:
Physical Address:
Facility Contact: + L Title: Phone No:
Onsite Representative-- Ic i K Integrator: ueX� _
Certified Operator: —__ f-�-� Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [� e [� i [� is Longitude: E__1 ° EJ u
Design Current Design Current Design
Swine Capacity Population Wet Poultry Capacity Population Cattle .'Capacity
1 ❑ Layer
❑ Non -La et
❑ Wean to Finish
Wean to Feeder
Feeder to Finish 0
53 Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouits
❑ Other
Discharges & Stream Impacts
I _ Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
�..
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
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 ZI No ❑ NA [J NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
]KNo
❑ NA
❑ NE
❑ Yes
19 No
❑ NA
❑ NE
12128104 Continued

'
Facility Number:
j t5' — Date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes 0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes [R No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in). 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes [&No ❑ NA ❑ NE
Oe/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes [-No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat; notify DWQ
7. Do any of the structures need maintenance or improvement?
91Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes [KNo ❑ 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 (A No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes 0 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes X[No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 1 o Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidennce of Wind Drift El Application Outside of Area
12. Crop type(s) .1r('XGiu?d
13. Soil type(s) 44—aax1
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 W No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes MNo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes RNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes X No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
vv
Reviewer/Inspector Name Phone: �/ 33i1t7
Reviewer/Inspector Signature: Date:
ra1Z61Y4 i.onunueu

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ISNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Ed 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 C&No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes %No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 9 No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
10 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
CO No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
IQ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
JRNo
❑ 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
91 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
ZNo
❑ 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
CKNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
9 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
UNo
❑ NA
❑ NE
Comments and/or Drawings:
12128104

Type of Visit
ompliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical: Assistance
Reason for Visit
0outine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: ® ArrivaI Time: Departure Time: County Region:
Farm Name: Owner Email:
Owner Name:11�1��_7�m� ��G ___ Phone:
Mailing Address:
Phvsical Address:
Facility Contact: u f\ r rt Title:
Onsite Representative:
Certified Operator: ✓`�'-
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator:
Operator Certification Number: Ta r J___
Back-up Certification Number:
Latitude: = n = ' F—I 41 Longitude: ❑ o ET
❑ a
YID
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
# ❑ La er
❑ Non -La er
❑ Wean to Finish
[$-Wean to Feeder
Other
❑ Other i
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated av El ElApplication Field ❑ Other
a. Was the conveyance man-made?
Design Current.
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non-Dairy-
0 Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cowi
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?
IM
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated av El ElApplication Field ❑ Other
a. Was the conveyance man-made?
Design Current.
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non-Dairy-
0 Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cowi
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?
IM
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
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?
IM
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
nNo
❑ NA
❑ NE
❑ Yes
9No
❑ 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
29-No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
El Yes
&N0
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): a;70 D
Observed Freeboard (in): J 10
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
4 No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
[&No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
RNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[2 No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
El Yes
nd No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
MNo
❑ NA ❑ NE
maintenance/improvement?
It. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
MNo
❑ 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 Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[&Vo
❑ 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
LgNo
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
(RNo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
®.No
❑ NA ❑ NE
Reviewer/Inspector Name YG !"" '1rc�'`
z:� , Phone:
Reviewer/Inspector Signature: Date: a�
12128104 Continued

• Facility Number.' Date of Inspection �b
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. ❑ W`UP ❑ Checklists ❑ Desig
n 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 ❑ Stacking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑Yes
❑ 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
❑ No
❑ NA
❑ NE
Outer Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (icl discharge, freeboard problems, over application)
32,
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Ad4dthonal'Gomrnents,an'Wor.Drawings:
12128104
12128104

(Type of Visit 0 Compliance inspection O Operation Review O Lagoon Evaluation , 'A
Reason for Visit 0 Routine O Complaint 0 Follow up O Emergency Notification O Other ❑ Denied Access
IDate or Visit: � 2 Tune: 30
Facility Number Z [ Y!v
O Not O erational O Below Threshold
.Permitted PiCertified [3 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: .__._._._----------
Farm Name: ........ Zi,v e frp v�`�" . i* _i Z _. County:
Owner Name: __LLGi��^.........C`Q S.?!!t.............. _ ._ ..... Phone No: . _ 910 — 2 B. Zr._._ ....._.
Mailing Address: .
- P max .:..._.... G _._has ...fi; rr _.� .N ...W .?� y
Facility Contact: .._.1�. ' v�!Lp F _....? W� t _. Title: . . ......... . .... . . . ....... . .................. ..... ....... Phone No:
p r
Onsite Representative:.... LZ.L�r�(!,! Pam. „...-�r!'�i'�'�_. „. _. Integrator: _.. 9 r_gy, —...
Certified Operator:.W _. JBr �mV...� .. A� M v�o�eOperator Certification Number:.,_,..2 %g @_5_7E__
i. __ _ . _.
Location of Farm:
21 Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �* �u Longitude • 4 64
-
Destga Current w �. Design
Current Design Current
swine,
an
Pool Cattle Ca `
�]'
„Ca
.Po uiation, ,. ci
Po ulaeon _. . r.. _
_
Layer10
Dairy--
IN
❑ Non -Layer
Non -Dairy
�
1 Other
,
m
Total Design Ca 'Pah' `� 840Y
El
r
Totail'SSL�1�
.,x
yNtimber of Lagoons Z
Wean to Feeder
DO
goo
Feeder to Finish
yp
Farrow to Wean
Q0(j
Farrow to Felder
Farrow to Finish
Gilts
Boars
Discharges & Stream impacts
I. Is any discharge observed from any part of the operation? [I Yes Mio
Discharge originated at: [I Lagoon [I Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) El Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes o
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes %No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? El Spillway ❑ Yes PNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ................ I ................ _ ,z.___...._................................
Freeboard (inches): Z
12112103 Continued

Facili6 Number: $2. — I Lj(p Date of inspection
r
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes KNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes O'No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes Z.,No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes MNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level [:]Yes KNo
elevation markings?
Waste Aunlication
10. Are there any buffers that need maintenancelimprovement? ❑ Yes ['No
11. is there evidence of over application? If yes, check the appropriate box below. ❑ Yes F No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type �erv►1�7�a . 5 seta i� A ray �.
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 KNo
b) Does the facility need a wettable acre determination? ❑ Yes C9No
c) This facility is pended for a wettable acre determination? ❑ Yes KNo
15. Does the receiving crop need improvement? ❑ Yes 10 No
16. Is there a lack of adequate waste application equipment? ❑ Yes Mo
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 5A 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 KNo
Air Quality representative immediately.
❑ Final Notes
-+. 4-o
Lv{ wce15
ar-ov­%.J
kcmL aQ 4 v1+cx+ w9_V_V.
l a _ S pc& V "A we -eel
VA (I x f O..-
-c-; eA CIS
ur4Q k. .
4. Qz seaa 41-C +-bP O-C
vM� ve C.otirLr .
Reviewer/Inspector Name
Reviewer/Inspector Signature Date. ZW O Y ^
1criZivj t.annnuea

Facility Number: 8 Z — i j(p Date of Inspection '1-D
r'
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes IgNo
22. Does the facility fail to have all cm onents of the Certified Animal Waste Management Plan readily available?
(ie/ WLFl�t� checklisesigj!m , etc.) ❑ Yes ER No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [KNO
❑ Waste Applicatiofo'�D Freeboadt""O Waste Analysibl*"❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
[&No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
CgNo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
JR No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
J?LNo
28. Does facility require a follow-up visit by same agency?
❑ Yes
KNo
24. Were any additional problems noted which cause noncompliance of the Certified AWMP.
❑ Yes
R,No
NPDES Permitted Facilities
30_ Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
_2SYes
❑ 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
&No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes I? No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ® No
❑ Stocking Form✓❑ Crop Yield ForsK ❑ Rainf&- ❑ Inspection After 1" Rahr'
❑ 120 Minute Inspectioge ❑ Annual Certification Forn1,"'�
No violations or deficiencies were noted during this visit- You will receive no further correspondence about this visit.
12112103

Division of Environmental Management
Animal Feedlot Operations Site Visitation Record
Date: 3
Tint:
General Informgtion:
Farm Name: RoyL Qotmiy: x a w
Owner Name: ne No•
On Site Representative: Integrator. yr
MaUingAddress-._aqja fit.
Physical
Latitude: / / ^ Lonotude: / /
Qneration Descriptiol]: (based on dedp characterisft)
e of Swine No. o Animals Type of Poultry No. of Animals Type of Ca trk No. of Animals
O Dyer O Dairy
O Nmwy 0 Noa-Layer O Beef
O Feeder
Dther7ipe of Livestock Number ofAnImah:
Number of Lagoons:(include in the Drawings and Observations the freeboard of each' INPM)
Facility InsperiQm
Lagoon .
Is Lagoon(s) freeboard less than I foot + 25 year 24 hour storm storage?:
Yes 0
Nc�9,
Is seepage observed from the lagoon?:
Yes a
Nog -
Is erosion observed?:
Yes a
No
Is any discharge observed?
Yes O
No
0 khan -made 0 Not Man-made
Cover 0W
Does the facility need more acreage for spraying?:
Yes O
Nop
Does the cover crop need improvement?:
Yes D
. NoV
(Alt the crops which nerd imprownwur)
170
tkop Acreage:,
Setback Criteria - -
Is a dwelling located withiti 200 feet of waste application?
Yes D
Noll
• -Is a well located within 100 feet of waste application?
Yes 0
Vo�3
Is animal waste stockpiled within 100 feet of USGS Blue Line Stream?
Yes O
N
Is animal waste land appried of spray irrigated within 25 feet of Blue Line Stream?
Yes
AOI — Jsaaar7 174996
-

l4l�rrt�ee�s�Ct
Does the facuity maintenance need improvement? Yes Cl No ll�
h thine evidence of past discharge from any part of the operation? Yes O No�
Does record keeping need improvement? Yes O NoU
+4 Did the facility fail to have a copy of the Animal Waste Management Plan on site? Yes O No,'Q:,
Explain any Yes answas-
er
signatmt: Dane:
U. AtraAmentt rNeeded
cc F=Hiry Asm- anew Unix
DrayIngs or bservatiots:
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State of North Carolina
Department of Environment,
' Health and Natural Resources
Fayetteville Regional Office
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
Andrew McCall, Regional Manager
DIVISION OF ENVIRONMENTAL, MANAGEMENT
November 9, 1994
Murphy Family Farms, Inc.
Riverfront II (Quarter M Farms)
9419 Tomahawk Road (Hwy. 41)
Harrells, NC 28444
SUBJECT: Compliance Inspection
Sampson County
Dear Farm Manager:
On November 1994, an inspection of your animal operation was
performed by the Fayetteville Regional Office (FRO). Please find enclosed a
copy of our Compliance Inspection Report for your information. It is the
opinion of this office that this facility is in compliance with 15A NCAC 2H,
Part .0217, and that Animal Waste Management is being properly performed.
Should you have any questions regarding this matter, feel free to contact
me at (910) 486-1-541.
Sincerely,
./�YA oe4n
Grady Ekbson
Environmental Engineer
Enclosure
cc: Facility Compliance Group
Gary Scalf
Wachovic Buiidng, Sdte 714. Fayetteville, North Carolina 28301-5043 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer W% recycled/ 10% post -consumer paper

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WORTH CAROLING DEPAR7PnW OF ENVIRONMENT, HEALTH & NATURAL RESOURCES
4 DIVISION OF
Fayetteville Regional Office
Animal Operation Compliance inspection Form
All questions answered negatively will be discussed in sufficient detail in
the Comments Section to enable the deemed Permittee to perform the appropriate
corrections:
SECTION I
Animal__Operation_Type:
Horses, cattle, swine, poultry, or sheep
SEC.'TION II
1. Does the number and type of animal meet or exceed
the (.0217) criteria? [Cattle (100 head),
horses (75), swine (250), sheep (1,000), and
poultry (30,000 birds with liquid waste
system)]
2. Does this facility meet criteria for
Animal Operation REGISTRATION?
3. Are animals confined fed or maintained
in this facility for a 12-month period?
4. Does this facility have a CBRTiFI� ANIMAL
WASTE MANAGEl= PLAN?
5. Does this facility maintain waste management
records (Volumes of manure, land applied,
spray irrigated on specific acreage with
specific cover crop)?
G. Does this facility meet the SCS minimum
setback criteria for neighboring houses,
wells, etc?
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;SECTION III
Fuld Site Management
1. Is animal waste stockpiled or lagoon
construction within 100 ft. of a USGS
Map Blue Line Stream?
2. Is animal waste land applied or spray
irrigated within 25 ft. of a USGS Map
Blue Line Stream?
3. Does this facility have adequate acreage
on which to apply the waste?
4. Does the land application site have a
cover crop in accordance with the
CERTIFICATION PLAN?
5. Is animal waste discharged into waters of
the state by man-made ditch, flushing system,
or other similar man-made devices?
G. Does the animal waste management at this
farm adhere to Best Management Practices
(BMP) of the approved CERTIFICATION?
7. Does animal waste lagoon have sufficient
freeboard? How much? (Approximately 2 ft )
8. Is the general condition of this CAFO facility,
including management and operation,
satisfactory?
s
Comments
Section II (5) and Section III (4 and 6):
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This facility has a certified plan into DEM. It is currently under
construction and no animals are yet housed. The waste land application
acreage is currently being cleared and all waste from Riverfront I and
Riverfront II will be managed together on entire acreage.

State of North Carolina
Department of Environment,
Health and Natural Resources.
Fayetteville Regional Office
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
Andrew McCall, Regional Manager
�EHNR
DIVISION OF ENVIRONMENTAL MANAGEMENT'
November 9, 1994
Murphy Family Farms, Inc.
Riverfront I (Quarter M Farms)
9419 Tomahawk Road (Hwy. 41)
Harrells, NC 28444
SUBJECT:
Farm Manager:
Compliance Inspection
Sampson County
On November 8, 1994, an inspection of your animal operation was performed
by the Fayetteville Regional Office (FRO). Please find enclosed a copy of our
Compliance Inspection Report for your information. It is the opinion of this
office that this facility is in compliance with 15A NCAC 2H, Part .0217, and
that Animal Waste Management is being properly performed.
Should you have any questions regarding this matter, feel free to contact
me at [phone].
Sincerely,
'S4 g��Z�
Grady bobson
Environmental Engineer
Enclosure
cc: Facility Compliance Group
Gary Scalf
Wachovia Building, Suite 714, Fayetteville, North Carolina 28301-9043 Telephone [phone] FAX [phone]
An Equal Oppodu-ity Affirmative Action Employer 5096 recycled/ 10% post -consumer paper

C
NORTH CAROLINA DEPARTKMT OF ENVIRamm, HEALTH & NATURAL RESOURCES
DIVISION OF ENYI 10PAGMAL MWAGEMENT
Fayetteville Regional Office
Animal Operation Compliance Inspection Form
Riverfront I (Quarter M Farms) 1 11/8/94 1 Q River
9419 Tomahawk Road (Hwy. 41)
Harrells, NC 28444
All questions answered negatively will be discussed in sufficient detail in
the Comments Section to enable the deemed Permittee to perform the appropriate
corrections:
SECTION I
Animal Operation Tyne:
Horses, cattle, saline, poultry, or sheep
SECTION II
1. Does the number and type of animal meet or exceed
the (.0217) criteria? (Cattle (100 head),
horses (75), swine (250), sheep (1,000), and
poultry (30,000 birds with liquid waste
system)]
2. Does this facility meet criteria for
Animal Operation REGISTRATION?
3. Are animals confined fed or maintained
in this facility for a 12-month period?
4. Does this facility have a CERTIFIED ANIMAL
WASTE MANAGERENT PLAN?
5. Does this facility maintain waste management
records (Volumes of manure, land applied,
spray irrigated on specific acreage with
specific cover crop)?
6. Does this facility meet the SCS minimum
setback criteria for neighboring houses,
wells, etc?
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Ei_eld__Site Management
1. Is animal waste stockpiled or lagoon
construction within 100 ft. of a USGS
Map Blue Line Stream?
2. Is animal waste land applied or spray
irrigated within 25 ft. of a USGS Map
Blue Line Stream?
3. Does this facility have adequate acreage
on which to apply the waste?
4. Does the land application site have a
cover crop in accordance with the
CERTIFICATION PLAN?
5. Is animal waste discharged into waters of
the state by man-made ditch, flushing system,
or other similar man-made devices?
6. Does the animal waste management at this
farm adhere to Best Management Practices
(BMP) of the approved CERTIFICATION?
7. Does animal waste lagoon have sufficient
freeboard? How much? (Approximately 1-10 ft )
8. Is the general condition of this CAFO facility,
including management and operation,
satisfactory?
S2=1OH
Comments
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Section III (Nos. 4 and 6): This facility is a relatively new facility that
is currently under construction with animals stocked which is okay since it
has the appropriate certification. The land on which the waste is being
cleared will have a cover crop by the 180-day period in the certification.
The lagoon with over 10 feet of freeboard has adequate capacity until the land
area is ready. This is quite an impressive facility with thought for wildlife
habit.