310401_INSPECTIONS_20171231

NUH I H LAHULINA
Department of Environmental Qual

►f
1 101 C/o
Type of Visit: (O Com lance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
wi rw r r.�
Date of Visit: / Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: �1 /�� Title: " Phone:
Onsite Representative: ` A c ( (V J9l e' S Integrator:
Certified Operator: Certification Number: % ! 6 3 z-
Back-up Operator:
Location of Farm: Latitude:
Certification Number:
Longitude:
Design C■urgent Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Finish Layer
Design Current
Cattle Capacity Pop.
DairyCow
Da' Calf
Feeder
Nan -La er
EE]
o Finish
DairyHeifer
o Wean
to Feeder
pFarrow
to Finish
Design Current
lt , Ca aci P,o ,
D Cow
Non -Dairy
Beef Stocker
ers
Beef Feeder
R
Beef Brood Cow
ouits
=J
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
[] Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[:]Yes
E-.N
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility Number: Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Yz'
5. Are there any immediate threats to the integrity of any of the structures observed? [:]Yes E] 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 [I No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes E31No ❑ 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 fo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes [a'NO ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[]Yes
E:j 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
❑ <o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ENo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[J'No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections [:]Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [—]Yes �o ❑ 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 21412015 Continued

Eacili Number: - U d / Date of Inspection: /
24. D1d the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Yes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
�on-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? [:]Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus Ioss assessments (PLAT) certification? ❑ Yes ❑ No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [] Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes E 1Ve ❑ 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
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 fond ❑ Other:
❑ Yes ENo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
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
Cro ❑ NA ❑ NE
E�1�❑ NA ❑ NE
❑ NA ❑ NE
01
iZeviewerlInspector Signature: _ �— -r-� Dots: s�y 17
Page 3 of 3 21412015

i
Division of Water Resources
❑ Division of Soil and Water Conservation
Other Agency
Facility Number_ 310401 Facility Status: Active
Perms AWS310401
❑ Denied Access
Inpsection Type: Compliance Inspection
Inactive Or Closed Date:
Reason for Visit: Routine County:
Duplin Region:
Wilmington
Oats of visit. 08/18/2016 EntryTime: 10:00 am Exit Time: 10:45 am Incident 2
Farm Name: 3112
Owner Email:
Owner: Murphy -Brown LLC
Phone:
910-296-1800
Mailing Address: PO Box 487
Warsaw NC 28398
Physical Address: Sr 1900 1330 Lanefield Rd
Warsaw NC 28398
Facility Status: ❑ Compliant ❑ Not Compliant Integrator:
Murphy -Brown LLC
Location of Farm: Latitude:
34" 56' 01" Longitude:
78' 01' 49"
Southwest of Kenansville. On South side of SR 1900 approx. 0.4 mile West of Hwy 903.
Question Areas:
Dischrge & Stream Impacts Waste Col, Slor, & Treat
Waste Application
Records and Documents Other Issues
Certified Operator:
Operator Certification Number:
Secondary OIC(s):
On -Site Representative($): Name Title Phone
24 hour contact name Michael Norris
Phone:
Primary Inspector: Kevin Rowland Phone:
Inspector Signature: Date:
Secondary Inspector(s):
Inspection Summary:
page: 1

Permit: AWS310401 Owner - Facility : Murphy -Brown LLC Facility Number. 310401
Inspection ©ate: 08/18/16 Inppection Type: Compliance Inspection Reason for Visit: Routine
Waste Structures
DWgnated Observed
Type Identifier Closed Date Start Date Freeboard Freeboard
Lagoon 3112 19.00 39.00
page: 2

Permit: AWS310401 Owner - Facility: Murphy -Brown LLC Facility Number: 310401
Inspection Date. 08/18/16 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?
❑
M ❑
❑
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
0 ❑
❑
b. Did discharge reach Waters of the State? (if yes, notify DWQ)
❑
0 ❑
❑
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑
❑
❑
2. Is there evidence of a past discharge from any part of the operation? .
❑
M ❑
❑
3. Were there any observable adverse impacts or potential adverse impacts to Waters of the
❑
0 ❑
❑
State other than from a discharge?
Waste Collection. Storage & Treatment
Yes No Na No
4. Is storage capacity less than adequate?
1101111
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (Le./ large
❑
0011
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a
❑
■ ❑
❑
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
❑
M ❑
❑
8. Do any of the structures lack adequate markers as required by the permit? (Not applicable
❑
M ❑
❑
to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑
M ❑
❑
maintenance or improvement?
Waste Application
Yes No Na He,
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ M ❑ ❑
maintenance or improvement?
11. Is there evidence of incorrect application?
❑ 0110
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
❑
PAN?
❑
Is PAN > 10%/10 lbs.?
❑
Total Phosphorus?
❑
Failure to incorporate manure/sludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
page: 3

Permit: AWS310401 Owner - Facility: Murphy -Brown LLC Facility Number. 310401
Inspection Date: 08/18/16 Inpsection Type: Complianoe Inspection Reason for Visit: Routine
Waste Application
Yes
No Na No
Crop Type 1
Crop Type 2
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Soil Type 2
Soil Type 3
Soil Type 4
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste
❑0
❑
❑
Management Plan(CAWMP)?
15. Does the receiving crop and/or land application site need improvement?
❑
❑
❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
❑
■ ❑
❑
determination?
17. Does the facility lack adequate acreage for land application?
❑
❑
❑
18. Is there a lack of properly operating waste application equipment?
❑
❑
❑
Records and Documents
Yes
No Na Ne
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑
0 ❑
❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑
0 ❑
❑
If yes, check the appropriate box below
WUP?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Lease Agreements?
❑
Other?
❑
If Other, please specify
21. Does record keeping need improvement?
110110
If yes, check the appropriate box below.
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
❑
Weather code?
❑
Rainfall?
❑
Stocking?
❑
page: 4

Permit: AWS310401 Owner - Facility : Murphy -Brown LLC Facility Number. 31D401
Inspection Date: 08/18/16 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents
Yes No Na No
Crop yields?
❑
120 Minute inspections?
❑
Monthly and 1" Rainfall Inspections
❑
Sludge Survey
❑
22. Did the facility fail to install and maintain a rain gauge?
❑0
❑
❑
23. If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment
❑
❑
❑
(NPDES only)?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
0110
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check the
❑01111
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?
1101111
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
M ❑
❑
Other Issues
Yes No Na No
28. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑
■ ❑
❑
and report mortality rates that exceed normal rates?
29. At the time of the inspection did the facility pose an odor or air quality concern? If yes,
❑
❑
❑
contact a regional Air Quality representative immediately.
30. Did the facility fail to notify regional DWQ of emergency situations as required by Permit?
❑
0 ❑
❑
(i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility?
❑
■ ❑
❑
If yes, check the appropriate box below.
Application Field
❑
Lagoon / Storage Pond
❑
Other
❑
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or
❑
❑
❑
CAWMP?
33. Did the Reviewerlinspector fail to discuss reviewfinspection with on -site representative?
❑
❑
❑
34. Does the facility require a follow-up visit by same agency?
❑
■ ❑
❑
page: 5

0 Division of Water Resources
❑ Division of Soil and Water Conservation
❑ Other Agency
Facility dumber: 310401 Facility Status: Active
Permit: AWS310401
❑ Denied Access
Inppection Type: Compliance Inspection
Inactive Or Closed Date:
Reason for Visit: Routine County:
Duplin • Region:
Wilmington
Cate of visit: 03/25/2015 Entry Time: 03:30 pm Exit Time: 4:30 pm Incident s
Farm Name: 3112
Owner Emall:
Owner: Murphy -Brown LLC
Phone:
910-296-1800
Mailing Address: PO Box 487
Warsaw NC 28398
Physical Address- Sr 1900 1330 Lanefleld Rd
Warsaw NC 28398
Facility Status: ❑ Compliant ❑ Not Compliant Integrator:
Murphy -Brown LLC
Location of Farm: Latitude:
34° 56' 01" Longitude:
78' 01' 49"
Southwest of Kenansville. On South side of SR 1900 approx. 0.4 mile West of Hwy 903.
Question Areas:
Dischrge & Stream impacts Waste Cal, Star, & Treat
Waste Application
Records and Documents Other Issues
Certified Operator: Operator Certification Number.
Secondary OIC(s):
On -Site Representative(s): Name Title Phone
24 hour contact name Michael Norris Phone:
On -site representative Michael Norris Phone:
Primary Inspector: Kevin Rowland Phone:
Inspector Signature: Dale:
Secondary Inspector(s):
Inspection Summary:
page: 1

Permit: AWS310401 Owner - Facility : Murphy -Brown LLC Facility Number. 310401
Inspection Date: 03/25/15 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Waste structures
Disignated Observed
Type Identifier Closed Date Start Date Freeboard Freeboard
Lagoon 3112 19.00 28.00
page: 2

5
Permit: AWS310401 Owner - Facility : Murphy -Brown LLC Facility Number. 310401
Inspection Date: 03/25/15 Iripsection Type: Compliance Inspection Reason for Visit: Routine
Discharges & Stream Impacts
Yes No Na Ne
1. Is any discharge observed from any part of the operation?
❑0
❑
❑
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
0 1311
b. Did discharge reach Waters of the State? (if yes, notify DWQ)
❑
0 ❑
❑
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑
0 1311
2. Is there evidence of a past discharge from any part of the operation?
❑
0 1113
3. Were there any observable adverse impacts or potential adverse impacts to Waters of the
❑
❑
❑
State other than from a discharge?
Waste Collection, Storage & Treatment
Yes
No Na No
4. Is storage capacity less than adequate?
❑
M ❑
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (I.e./ large
❑
M ❑
❑
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a
❑
0 ❑
❑
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
❑
M ❑
❑
8. Do any of the structures lack adequate markers as required by the permit? (Not applicable
❑
0 ❑
❑
to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑
0 ❑
❑
maintenance or improvement?
Waste Application
Yes No Na No
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ ❑ ❑
maintenance or improvement?
11. Is there evidence of incorrect application?
❑ ❑ ❑
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
❑
PAN?
❑
Is PAN > 10%/10 lbs.?
❑
Total Phosphorus?
❑
Failure to incorporate manure/sludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
page: 3

M
Permit: AWS310401 Owner - Facility : Murphy -Brown LLC Facility Number. 310401
Inspection Date: 03/25/15 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Waste Application
Yes No Na No
Crop Type 1
Crop Type 2
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Soil Type 2
Soil Type 3
Soil Type 4
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste
❑
0 ❑
❑
Management Plan(CAWMP)?
15. Does the receiving crop and/or land application site need improvement?
❑
0 ❑
❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
❑
M ❑
❑
determination?
17. Does the facility lack adequate acreage for land application?
1101111
18. Is there a lack of properly operating waste application equipment?
❑
❑
❑
Records and Documents
Yes
No Na Me
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑
M ❑ ❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑
■ ❑ ❑
If yes, check the appropriate box below.
WUP?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Lease Agreements?
❑
Other?
❑
If Other, please specify
21. Does record keeping need improvement?
❑
moo
If yes, check the appropriate box below.
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
❑
Weather code?
❑
Rainfall?
❑
Stocking?
❑
page: 4

Y
Permit: AWS310401 owner - Facility : Murphy -Brown LLC Facility Number. 310401
Inspection Date: 03/25/15 Inppection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents
Yes
No Na No
Crop yields?
❑
120 Minute inspections?
❑
Monthly and 1" Rainfall Inspections
❑
Sludge Survey
❑
22. Did the facility fail to install and maintain a rain gauge?
❑
N ❑
❑
23. If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment
❑
E ❑
❑
(NPDES only)?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
N ❑
❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check the
❑
N ❑
❑
appropriate box(es) below:
Failure to complete annual sludge survey
❑
Failure to develop a POA for sludge levels
❑
Non -compliant sludge levels in any lagoon
❑
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑
❑
❑
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
❑
❑
Other Issues
Yes No Na No
28. Did the facility fail to properly dispose of dead animals within 24 hours and/or document.
1301111
and report mortality rates that exceed normal rates?
29. At the time of the inspection did the facility pose an odor or air quality concern? If yes,
110110
contact a regional Air Quality representative immediately.
30. Did the facility fail to notify regional DWQ of emergency situations as required by Permit?
❑
❑
❑
(i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility?
❑
❑
❑
If yes, check the appropriate box below.
Application Field
❑
Lagoon / Storage Pond
❑
Other
❑
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or
❑
❑
❑
CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑
❑
❑
34. Does the facility require a follow-up visit by same agency?
❑
■ ❑
Cl
page: 5
a

(Type of Visit: Q'Cliance Inspection U Operation Review Q Structure Evaluation U Technical Assistance I
Reason for Visit: e Routine Q Complaint 0 Follow-up 0 Referral 0 Emergency O Other 0 Denied Access
Date of Visit: Arrival Time: f t Departure Time: ounty:
Farm Name: %;-z&? 2 Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: mlchw[
Certified Operator:
Title:
Phone:
Phone:
Integrator:
I
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Region: [N r
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Non -La er I
Design C•arrent
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
Layers
Non -Layers
Pullets
Turke s
Turke Poults
Other
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Gilts
Boars
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes N No ❑ NA ❑ NE
❑ Yes Z—No ❑ NA ❑ NE
❑ Yes k] No ❑ NA ❑ NE
❑ Yes �No
❑ Yes �T3<0
No"
❑ Yes
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: - Date of inspection:
7.7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
JON,o ❑ NA ❑ NE
O'No ❑ NA ❑ NE
Structure 6
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 property addressed and/or managed through a ❑ Yes ff 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 'Z No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes Z 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 �o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes .E:fNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ YesPrNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[:]Yes ZNo
❑ 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 J�fNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes PrNo
❑ 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 ONo
❑ 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 3 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 12,'No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes �' o ❑ 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 �o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑Yes ,PTNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[-]Yes rN- o
❑ NA
❑ NE
and report mortality rates that were higher than normal?
r
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes C214o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
j
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes PrNo
❑ 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 PNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes jz No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes P No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[:]Yes o
❑ NA
❑ NE
Comments (refer -to question ff): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Phone:
Reviewer/Inspector Signature:
Date:
Page 3 of 3
14/201

,,
,fr
0 Division of Water Resources
❑ Division of Soil and Water Conservation
❑ Other Agency
Facility Number:
310401 Facility Status:
Active Permit AWS310401
❑ Denied Access
Inpsection Type:
Compliance Inspection
Inactive Or Closed Date:
Reason for visit:
Routine
County: Duplin Region:
Wilmington
Date of visit:
03/07/2013 EntryTime: 10:00 am
Exit Time: 11:00 am Incident e
Farm Name:
3112
Owner Email:
Owner.
Murphy -Brown LLC
Phone:
910-296-1800
Mailing Address: PO Box 487 Warsaw NC 28398
Physical Address: Sr 1900 1330 Lanefield Rd Warsaw NC 28398
Facility Status: ❑ Compliant ❑ Not Compliant Integrator Murphy -Brown LLC
Location of Farm: Latitude: 34' 56' 01" Longitude: 78° 01' 49"
Southwest of Kenansville. On South side of SR 1900 appmx. 0.4 mile West of Hwy 903.
Question Areas:
Dischrge & Stream impacts Waste Col, Stor, & Treat Waste Application
Records and Documents Other Issues
Certified Operator: Operator Certification Number:
Secondary OIC(s):
OnStte Representative(s): Name Title Phone
24 hour contact name Michael Norris Phone
On -site representative Michael Norris Phone
Primary Inspector: Kevin Rowland Phone:
Inspector Signature: Date:
Secondary Inspector(s):
Inspection Summary:
poa needed for sludge
page_ 1

Permit: AWS310401 Owner - Facility : Murphy -Brown LLC Facility Number. 310401
Inspection Date: 03/07/13 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Waste Structures
Disignated Observed
Type Identifier Closed Date Start Date Freeboard Freeboard
Lagoon 3112 19.00
page: 2

Permit: AWS310401 Owner - Facility : Murphy -Brown LLC Facility Number. 310401
Inspection Date: 03/07/13 Inppection Type: Compliance Inspection Reason for Visit: Routine
Discharges & Stream Impacts
Yes
No Na No
1. Is any discharge observed from any part of the operation?
❑
❑
❑
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
❑
❑
b. Did discharge reach Waters of the State? (if yes, notify DWQ)
❑
M ❑
❑
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑
M ❑
Cl
2. Is there evidence of a past discharge from any part of the operation?
❑
0110
3. Were there any observable adverse impacts or potential adverse impacts to Waters of the
❑
moo
State other than from a discharge?
Waste Collection, Storage & Treatment
Yes No Na Ne
4. Is storage capacity less than adequate?
❑
0 ❑
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (Le./ large
❑
0 ❑
❑
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a
❑
0 ❑
❑
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
❑
M ❑
❑
8. Do any of the structures lack adequate markers as required by the permit? (Not applicable
❑
❑
❑
to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑
❑
❑
maintenance or improvement?
Waste Application
Yes No Na Ne
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ 0 ❑ ❑
maintenance or improvement?
11. Is there evidence of incorrect application?
❑ 0 ❑ ❑
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
❑
PAN?
❑
Is PAN 5 10%/10 lbs.?
❑
Total Phosphorus?
❑
Failure to incorporate manure/sludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
page: 3

Permit: AWS310401 Owner - Facility : Murphy -Brown LLC Facility Number. 310401
Inspection Date: 03/07/13 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Waste Application
Yes No Na No
Crop Type 1
Crop Type 2
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Soil Type 2
Soil Type 3
Soil Type 4
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste
❑
0 ❑
❑
Management Plan(CAWMP)?
15. Does the receiving crop and/or land application site need improvement?
❑
❑
❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
❑
❑
❑
determination?
17. Does the facility lack adequate acreage for land application?
❑
❑
❑
1 B. Is there a lack of properly operating waste application equipment?
❑
❑
❑
Records and Documents
Yes No Na No
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑
0 ❑
❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑N
❑
❑
If yes, check the appropriate box below.
WUP?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Lease Agreements?
❑
Other?
❑
If Other, please specify
21. Does record keeping need improvement?
❑
0 ❑
❑
If yes, check the appropriate box below.
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
❑
Weather code?
❑
Rainfall?
❑
Stocking?
❑
page: 4

Permit: AWS310401 Owner - Facility : Murphy -Brown LLC Facility Number: 310401
Inspection Date: 03/07/13 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents
Yes
No Na No
Crop yields?
❑
120 Minute inspections?
❑
Monthly and 1" Rainfall Inspections
❑
Sludge Survey
❑
22. Did the facility fail to install and maintain a rain gauge?
❑
MCI
❑
23. If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment
❑
M ❑
❑
(NPDES only)?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
00
❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check the
❑
0 ❑
❑
appropriate box(es) below:
Failure to complete annual sludge survey
❑
Failure to develop a POA for sludge levels
❑
Non -compliant sludge levels in any lagoon
❑
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑
❑
❑
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
❑
❑
Other Issues
Yes No Na Me
28. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑
■ ❑
❑
and report mortality rates that exceed normal rates?
29. At the time of the inspection did the facility pose an odor or air quality concern? If yes,
110011
contact a regional Air Quality representative immediately.
30. Did the facility fail to notify regional DWQ of emergency situations as required by Permit?
❑
M ❑
❑
(i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility?
❑M
❑
Cl
If yes, check the appropriate box below.
Application Field
[]
Lagoon I Storage Pond
❑
Other
❑
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or
❑
M ❑
❑
CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑
M ❑
❑
34. Does the facility require a follow-up visit by same agency?
Cl
0 ❑
❑
page: 5

r
E Division of Water Resources
❑ Division of Soil and Water Conservation
❑ Other Agency
Facility Number: 310401 Facility Status: Active Permit AWS310401 ❑ Denied Access
Inpsectlon Type: Compliance Inspection Inactive Or Closed Date:
Reason for Visit: Routine
Date of Visit: 03/28QO12 Entry Time: 09:00 am Exit Time
Farm Name: 3112
Region:
Incident #
Owner Email:
Owner Murphy -Brown LLC Phone:
Mailing Address:
Physical Address:
County: Duplin
10:00 am
PO Box 487 Warsaw NC 28398
Sr 19001330 Lanefield Rd Warsaw NC 28398
Facility Status: ❑ Compliant ❑ Not Compliant Integrator.
Location of Farm: Latitude:
Southwest of Kenansville. On South side of SR 1900 approx. 0.4 mile West of Hwy 903.
Wilmington
910-296-1800
Murphy -Brown LLC
34° 56' 01" Longitude: 78° 01' 49"
Question Areas:
Dischrge & Stream Impacts Waste Col, Stor, & Treat Waste Application
Records and Documents Other Issues
Certified Operator: Operator Certification Number.
Secondary OIC(s):
On -Site Representatives): Name Title Phone
On -site representative Michael Norris Phone
Primary Inspector: Kevin Rowland Phone:
Inspector Signature: Date:
Secondary Inspector(s):
Inspection Summary:
page: 1

Permit: AWS310401 Owner - Facility : Murphy -Brown LLC Facility Number. 310401
Inspection Date: 03/28/12 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Waste Structures
Disignated Observed
Type Identifier Closed Date Start Date Freeboard Freeboard
Lagoon 3112 19.00
page: 2

Permit: AWS310401 Owner - Facility : Murphy -Brown LLC Facility Number. 310401
Inspection Date: 03/28/12 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Discharges & Stream Impacts
Yes
No Na No
1. Is any discharge observed from any part of the operation?
❑
❑
❑
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
M ❑
❑
b. Did discharge reach Waters of the State? (if yes, notify DWQ)
❑
M ❑
❑
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑
❑
❑
2. Is there evidence of a past discharge from any part of the operation?
❑
M ❑
❑
3. Were there any observable adverse impacts or potential adverse impacts to Waters of the
❑
M ❑
❑
State other than from a discharge?
Waste Collection. Storage & TreatMent
Yes No Ka Ne
4. Is storage capacity less than adequate?
❑
❑
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (Led large
❑
M ❑
❑
trees, severe erosion, seepage, etc.)?
6_ Are there structures on -site that are not properly addressed and/or managed through a
❑
M Cl
❑
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
❑
M ❑
❑
8. Do any of the structures lack adequate markers as required by the permit? (Not applicable
❑
0 ❑
❑
to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑
0 ❑
❑
maintenance or improvement?
Waste Application
Yes No Na No
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑0 ❑ ❑
maintenance or improvement?
11. Is there evidence of incorrect application?
❑ m ❑ ❑
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
❑
PAN?
❑
Is PAN > 10%/10 lbs.?
❑
Total Phosphorus?
❑
Failure to incorporate manure/sludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
page: 3

Permit: AWS310401 Owner - Facility : Murphy -Brown LLC Facility Number. 310401
Inspection Date: 03/28/12 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Waste Application Yes No Na No
Crop Type 1
Crop Type 2
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Soil Type 2
Soil Type 3
Soil Type 4
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste
❑
❑
❑
Management Plan(CAWMP)?
15. Does the receiving crop and/or land application site need improvement?
❑
0 ❑
❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
❑
0 ❑
❑
determination?
17. Does the facility lack adequate acreage for land application?
❑
0 ❑
C]
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?
❑
0 ❑
❑
20_ Does the facility fail to have all components of the CAWMP readily available?
1101111
If yes, check the appropriate box below.
WUP?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Lease Agreements?
❑
Other?
❑
If Other, please specify
21. Does record keeping need improvement?
❑ ❑ ❑
If yes, check the appropriate box below.
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
❑
Weather code?
❑
Rainfall?
❑
Stocking?
❑
page: 4

Permit: AWS310401 Owner - Facility : Murphy -Brawn LLC Facility Number. 310401
Inspection Date: 03/28/12 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents
Yes No Na No
Crop yields?
❑
120 Minute inspections?
❑
Monthly and 1" Rainfall Inspections
❑
Sludge Survey
Cl
22. Did the facility fail to install and maintain a rain gauge?
❑
M ❑
❑
23. If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment
❑
❑
❑
(NPDES only)?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
❑
❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check the
❑
M ❑
❑
appropriate box(es) below:
Failure to complete annual sludge survey
❑
Failure to develop a POA for sludge levels
❑
Non -compliant sludge levels in any lagoon
❑
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑
0 ❑
❑
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
1101111
Otherlssues
Yes No Na No
28. Did the facility fail to property dispose of dead animals within 24 hours and/or document
1101111
and report mortality rates that exceed normal rates?
29. At the time of the inspection did the facility pose an odor or air quality concern? If yes,
1101111
contact a regional Air Quality representative immediately.
30. Did the facility fail to notify regional DWQ of emergency situations as required by Permit?.
❑
❑
❑
(i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility?
❑
❑
❑
If yes, check the appropriate box below.
Application Field
❑
Lagoon / Storage Pond
❑
Other
❑
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or
❑
0 ❑
❑
CAWM P?
33. Did the Reviewer/Inspector fail to discuss reviewfinspection with on -site representative?
110011
34. Does the facility require a follow-up visit by same agency?
❑
M ❑
❑
page: 5

Fad ity Number
II
Type of Visit 100060m
Reason for Visit
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Division of°Water Quality
Division of Soil and Water Conseryatton
0
Other.Agency _.. " ,•
tl�nce Inspection Q Operation Review O Structure Evaluation O Technical Assistance
utine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Arrival Time: arture Time: County:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Region
Phone No:
Integrator
Operator Certification Number: y C
Back-up Certification Number:
Latitude: = o = I = Longitude: = o = , ="
`�
b Destgn Current Destgn Current zv ` Destgn CYyrent:
3 Swine Capacity �Popnlatton Wet Poultry Capacity PopMatt©n_ Cattlze Capac�tyPopulatton
❑ Wean to Finish ❑ Layer
❑ Wean to Feeder ❑Non -La er
❑ Feeder to Finish��
❑ Farrow to Wean Dry Poultry
❑ Farrow to Feeder -
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other _
❑ Other"
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
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 ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: — Date of Inspection 6.; Z f /Mj " 7/v�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: /
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ieI large trees, severe.erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
I & Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
u
—..q++efk— sT4.^':
Comments (refer to question.#): Explain any YES answers and/or, any recommendations o"r„any other comments
.Use rawings of facility to better°explainsituations. (use additional pages as necessary):
jo
A.
Reviewer/Inspector Name �� Phone:
Reviewer/Inspector Signature: Date: c3 D
or
Page 2 of 3 12128104 1 Continued

-� -Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ 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 1 " Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ 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
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings: r
x„
W
�L
Page 3 of 3 12,128104

Fac'Cil Number
-0-6ivision of Water Quality �.
0 Division of goiland;Water: Conservation t
Q.; Others Agency,: ,
Type of Visit Otompliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit I-Emoutine O Complaint 0 Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: parture Time: County: Region:1�
Farm Name: J 0617- Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:.. M Z/ _3
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = o = i = Longitude: = o
Design Current• Destgng Current ,�; R " Design ;Cnrrent
Swtne Capacity �Populatton Wet Poultry �`Gapaci Populahonr Cattle CattleP Pul tion..
❑ Wean to Finish ❑ Layer 0 Dairy Cow I'
'. ❑ Wean to Feeder ❑ Non -Layer ❑ Dairy Calf
El Feeder to Finish [] Dai Heifer
El Farrow to Wean Dry Pou]try J� r El D Cow
❑ Farrow to Feeder - : .:r,..
❑La Layers El Non -Dairy
a El Farrow to Finish ❑Beef Stocker
❑ Gilts ❑ Non -Layers
z. ❑ Beef Feeder
El Boars El Pullets
❑ Beef Brood Co
❑ Turke s
Others;r s r:,
0 Turkey Points � x'' �.���� ��•-�
❑ Other ❑Other t+tumber o€ SVuctures
Dischart!es & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
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?
El Yes El No ❑NA ❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: — Q Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA ❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ 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 101bs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. 'Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Comments^(refer .to question ff): Explain any YES answers and/or any recommendations or any other comments ^v
Use drawings of facility to better explain situations (use additional pages as necessary' �)
Reviewer/Ins ector Name p'
p Phone: G
Reviewer/Inspector Signature: Date:
Page 2 of 3 408104 Continued

Facility Number: 3Z 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. ❑ VrUp ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Additional Comments and/or Drawings;
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
Page 3 of 3 12128104

.a
Q Division of Water Quality
Facility Number 0 Division of Soil and water Conservation
— — O Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I Arrival Time: r a Bgparture Time: County: h Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: - Q r
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
❑ Other
Owner Email:
Phone:
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Latitude: [= o = I = Longitude: 0 0 = f [= If
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turke Poults
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
I
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures: =.
b. Did the discharge reach waters of the State? (1f 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 fNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
tNo
❑ NA
❑ NE
❑ Yes dNo ❑ NA ❑ NE
12128104 Continued

Facility Number Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes L'Nlo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ YesNo ❑ NA ❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes AoNo ❑ 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? ❑ YesZ"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 ?1"No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Q<o ❑ NA ❑ NE
maintenance/improvement? �, /
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes I2'No El NA El NE
El Excessive Ponding El Hydraulic Overload El Frozen Ground El Heavy Metals (Cu, Zn, etc.) ///
[]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o
(((No
El NA
El NE
15. Does the receiving crop and/or land application site need improvement?
El
❑ NA
[I NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
No
P
El NA
El NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
df No
❑ NA
El NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
INO
❑ NA
❑ NE
Commentsa(referlto4queshon:#}Explaua any,�YESanswers and/or any�reeomineridatiions or any other'comments.
;Userdrswings of faeiliN to°better�expla n s�tuattons (use atltlrhonal pagessas a§sary) ,
r
Reviewer/Inspector Name �J Phone:-
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection 3
Reuuired 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
El Yes
❑ NA
❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
ONo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑
Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes dNo
❑ 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
IONo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
V(No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
6No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
6No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
VfNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ONo
❑ 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
&
❑ 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
VfNo
❑ 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
o
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
El YesfNc)
❑ NA
❑ NE
Additional Comments and/or Drawings:
L
12128104

0
Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit O Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: �Q Departure Time: County:
Farm Name: _ Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: t�r
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
LJ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Region:
Phone No:
Integrator:1114, 'Z&
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = I = Longitude: = ° = ` = "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
I' Non-Layet
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes �3 o ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes WNo
❑ Yes [;�No
❑ NA
❑ NE
❑ Yes �No
❑ NA
❑ NE
12128104 Continued

Facility Number: (j Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes P No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes 0 No
❑ NA ❑ NE
St ru re 1 Structure 2 Structure 3 Structure 4
Identifier:
Structure 5
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes 0No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
�/
❑ Yes LQ 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 EINO
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes ❑ado
El NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes [Xo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes o
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes po
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ONo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes J Z No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes �,PG0
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes P40
El NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ❑�
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
dOG f u e - ;7' ©7' 7 _/� �. �' T��� /won77
, l
�/`I/J �Q��.S GUCY • ��c�a-r—
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date:
I2128104 ," Continued
r.

Facility Number: — Date of Inspection
Required Records & Documents _,(
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ElZ Yes No ❑ 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 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 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
o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
51" o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�4o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
VNo
❑ 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'j2'No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
o
ON
ElNA
❑ 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
PNo
❑ 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
Ld No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
N
ElNA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12128104

—W Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
:::� 0 Other Agency
r
f Visit rlYCompiiance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
n for VisitJERoutine 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
l
Date of Visit: Arrival Time: / ! Departure Time: County: Region:
Farm Name: 12 Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Yhone No:
Onsite Representative: �! e Integrator: �r G
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Gliv
Location of Farm: Latitude: = = 4 =61 Longitude: = ° =' =
me
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
crary Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
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?
Page I of 3
El Yes El No El NA El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
12128104 Continued

Facility Number: ' — (7 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
IL . 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 l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name I L!!&kt &/ ! � / I Phone: c/ 0— 7Y(v
Reviewer/Inspector Signature: ZC Date: 6
Pape 2 of 121 /04 Continued

Facility Number: '3 — Date of Inspection
Reaiuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ 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
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
Cl Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
S� G✓ �� Ccn �s� /f �e ��
Page 3 of 3 12128104

Type of Visit erCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visitoutine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date or visit: Arrival Time: •� (1 Departure Time: County:
Farm Name: 4" Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 3i2 rx r�-
Certified Operator:
Back-up Operator:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Location of Farm: Latitude: [� o 0 l 0 « Longitude: E—_1 o = ' ED "
Design C•ucrent
Design
Current
esign
D11
Current
Swine
Capacity Population
Wet�Poultry. Capacity
Population :
Cattle C�paeity
Popuiation,
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non-Layet
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ DKY Cow
❑ Farrow to Feeder
❑ Non-DaiEy
❑ La ers
❑ Farrow to Finish
El Beef Stocker
❑ Gilts
on -Layers
El Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cowl
i
❑ Turkeys
Other
❑ Turkey Puults
Number of Structures:
❑ Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
❑ No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of past discharge from any part of the operation?
❑ Yes
❑ No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
❑ No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
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?
El Yes ❑No El NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or t 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Reviewer/Inspector Name. f `> s-'� Phone:
Reviewer/Inspector Signature: Z Date: 5PZ G
121281041 Continued

Facility Number: Date of Inspection G
Remired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ 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
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (iel 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
Additional Comments and/or Drawings:
o2l7 01 r s jzlrUC�n
1�eCara�s �22� �o� Or�xe��
12128104

Type of Visit Q'COmptiance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Time:
Not erational Q Below Threshold
Permitted )eCertifled © Conditionally Certified © Registered Date Last Operated or� Above Threshold: _....».. ».» ».
FarmName: ..... .»..... ............. ....................................... »................... .......-............•--............ County: »..... .owm!....» ».».......»........»...» ...................
Owner Name:
Mailing Address:
Facility Contact:
Phone No:
Tide: ........... . .......................................... Phone No:
Onsite Representative: •--•-!R- Integrator:
Certified Operator: -----------•-••- -_-----•--•..».».»....». _ .».».» » ».».....» ...........»... Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 9 " Longitude • 4 «
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d_ Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: »....»...-...I -- ---- ------- »..... .».... _ »» ..» ....».._._. ...... .
Freeboard (inches): 3 _
12112103
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
U40
❑ Yes
❑ Yes
<o
No
Structure b
Continued

Facility Number: 31 — (401 Date of Inspection S
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9_ Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenancehimprovement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type (Y)AT t/A &RM U D{) (ON
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes C o
❑ Yes 060
❑ Yes No
❑ Yes P4To ,
❑ Yes
❑ Yes ' �N0
❑ Yes
❑ Yes
[.f'�No
�p�R/
❑ Yes
El Yes
- N
❑ Y
No
❑ Yes 4io
_�
❑ Yes
❑ Yes No
Gimments (refer to question #) omme = "
rat❑ yld
Ees
—plii❑ Final_ Notesadz�a s�uao. (uedttronal pages Fie
Use drawings of iacuity to br as nsaryj Ceor-cpc
Is, OvFrrs�eD 6R.ap SAS P6a�
vVA5 XA,JEt1_rr16_-tTJVE,
-
T
_ •.. ".^'�' �� ,FF"".'.. S"..1_-�+r�--"-'TL;'y�_...�`zS^:.
Reviewer/Inspector Name Via: .,v L L�_VrtsF
..
ReviewerAnspector Signature: Date:
I2112103 Continued

Facility Number: _qOj Date of Inspection l I
. Required Records & Documents
/No
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
N
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
o
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
0 Yes
❑ No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
o
28. Does facility require a follow-up visit by same agency?
❑ Yes
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
o
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

31
-
Type of Visit compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 10,Aoutine O Complaint. O Follow up O Emergency Notification O Other
❑ Denied Access
Date of Visit: 2Ey D Time: 1 Z 30
Facility Number 3 / D
Q Not Operational Q Below Threshold
13 Permitted U Certified p Conditionally Certified © Registered Date Last Operated or Above Threshold: ... ..._ ._ ..
Farm Name; .......j .Z ........//................................- County: h',pU I $,
..._...........................................................
OwnerName: ........r�...r0(r.I. ►'`......... .......... ....................................... Phone No:...................................................................................
FacilityContact: .............................................................................. Title:..................................... Phone No:
MailingAddress:..........................................................................................................
Onsite Representative: Integrator: qT W h S o��—O )+ R
........................................................._...I..............�_� ..
Certified Operator:
Location of Farm:
Operator Certification Number: -• .............................. „....
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 4 96 Longitude • & ++
-_Design Current Design , Current _ Design Cii rent
iwlne Capacity Population . Poultry Capacity Population . Cattle Capacity - .Populatio
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Nnmber;of Lagoons ❑Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
�rr
r... x
HoldingPonds / Saud Traps = ❑ No Liquid Waste Management System
DischaMg & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes Q�No
Discharge originated at: [I Lagoon ❑ Spray Field [I Other
/
a. If discharge is observed, was the conveyance man-made? ❑ Yes ANo
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes &o
c. If discharge is observed. what is the estimated flow in gal/min? h 14
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes zVNo
2. is there evidence of past discharge from any part of the operation? ❑ Yes �No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ONO
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes )dNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier: ......................................... ...............................................................................................................................................
...............................
Freeboard (inches): 47-
5/00 Continued on buck

Facility_ N lzer: 3 j — Q Date of Inspection Z�
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenancetimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application_
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? I ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type P.' "`` `' d �1 Nek'4) M�Ov ct + u1 k 4
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspcctor fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
viQlajiQns ;off d f cienci vv�re pWo 006fig this;visit; - Yop %J11-tecgiye po futt#>Ior
:-.-corresndeuce:aboutithisvisit:.:.....................::...........:.:.....::
o .
tsrv(refeeth question#) ..Ei�
► :of facility to bette�`ell
T1t e At � �.� y aul reca�clS
Fes.. 3�ec=*) Asa
rise adthtioiiial esas n
ofr-e Y)eg4)� k 1.
❑ Yes Frio
❑ Yes PNo
❑ Yes No
❑ Yes No
❑ Yes ;;rNo
❑ Yes )zNo
❑ Yes 1p No
❑ Yes '91No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes &No
❑ Yes &No
❑ Yes f2fNo
❑ Yes 21No
❑ Yes d No
❑ Yes &No
❑ Yes �No
❑ Yes &NO
❑ Yes '0 No
❑ Yes,0 No
❑ Yes,-�No
�Im
Reviewer/Inspector Name Se7 rtcz.�t 'j f
Reviewer/Inspector Signature: Date: z Q' f 5100

Facgity Number: .7j -41 j Date of Inspection 2 +
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 'ONO
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes INo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ,,'O No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ONo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 9110
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? 0 Yes ❑ No
Additionalommen an or, rawings:
Akt
5100

Type of Visit O Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility�Numbe�r������
Date of Visit s-9-Z000 Printed on: 5/16/2000
ro Not Operational O Below Threshold
Permitted E3 Certified M Conditionally Certified [3 Registered Date Last Operated or Above Threshold: .................
FarmName: EarmAt2......................................................................................................... County: Duplxn .............................. .................. W.1110.........
Owner Name:
Facility Contact:
r.Q�r�'s.af.GaxAluna�,.irx�.................... Phone No: 9.10,2.6.489Q........................................._.................
Title:................................................................ Phone No:
Mailing Address: RO.Box.48..7.............................. Warsaw 28398.............
Onsite Representative:........................................................................................................... Integrator: .................................
Certified Operator: J viJd...................................... Tee .................................................... Operator Certification Number: .18. i.............................
Location of Farm:
...................................................................................................................................................................................................................................................................... #
za tltecst.a� �txatxsxidl�...Qa�.Saatllside.Q>f.Sl1i I9Q�..attpXn�,.Q.4.aaal�t'll�at.af.9Q3......................................................................................
..............................................................................................................................................................................................................................I.................
O1 S5
® Swine ❑ Poultry El Cattle [I Horse Latitude 34 • 56 23 u Longitude 78 " ' u
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
® Farrow to Feeder
2000
1950
❑ Farrow to Finish
❑ Gilts
❑ Boars
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge'?
Waste Collection & Treatment
❑ Yes 0 No
All
❑ Yes 9 No
❑ Yes N No
❑ Yes N No
❑ Yes iN No
4_ Is storage capacity (freeboard plus storm storage) less than adequate? © Spillway ❑ Yes X No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier; ...........................................................................................................................................................................................
Freeboard(inches):..19.5.............. .................................... ................................... .................................... .................................... ....................................

Facility Number: 31-4p1 Date of Inspection 5-9-2044 Printed on: 5/16/2000
S. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, 0 Yes N No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes N No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? [-]Yes N No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes N No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes N No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ® No
11. Is there evidence of over application? ❑ Excessive Ponding N PAN N Yes ❑ No
12. Crop type Coastal Bermuda (Hay) Small Grain Overseed
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes N No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes N No
b) Does the facility need a wettable acre determination? ❑ Yes (9 No
c) This facility is pended for a wettable acre determination? ❑ Yes N No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
4 •No•vi.olafians. ar.d'efrciericies•ivere.rioieil.dnii'ng ttiis'visii:: You-wilfreceiv.e.no hirtlier.
..........................................................
rnrrPcririni�; airi► ahrilit'thit.vici1t .. . . . . . . . . . . .
11 & 19 - Field # 1 - Hydrants # 5a & 5b and 6a & 6b have an over application of PAN due to Hurricane Floyd, Ect.
22 - Glen Davis stated he had talked with DWQ about over applications of PAN but was unsure if it was this farm.
Field # 1 that had the over application of PAN in 1999 was observed. The bermuda in this field was coming up fine.
❑ Yes N No
El Yes N No
❑ Yes N No
❑ Yes N No
N Yes ❑ No
❑ Yes N No
❑ Yes N No
N Yes ❑ No
[] Yes N No
❑ Yes N No
[] Yes N No
ReviewerlInspector Name

• Facility Number: 31-401 Date of Inspection 5-9-2000 Printed on: 5/16/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below El Yes 9 No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? El Yes ® No
29. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 19 No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? Yes No
30. Were any major maintenance problems with the ventilation fans) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? [j Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? 0 Yes H No

is Division of Water Quality /
Q Division of Soil and Water Conservation
_. Q Other Agency
Type of Visit 06Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit l$ Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit: �' 23 00 Time: J 3U Printed on: 7/21/2000
3 [ � 0
O Not Operational Q Below Threshold
Permitted © Certified 0 Conditionally Certified ❑ Registered Date Last Operated or Above Threshold: ............•.
Farm Name: 1e+ r, vh
..........................�............................................................................... County....... ��h
Owner Name: e "W "r/ �+'� t Phone 1S`o:
.. ..,......................................................................................
FacilityContact:.............................................................................. Title: ......... ....................................................... Phone No:...................................................
MailingAddress:.......................................................................................................................................................................................................... ..........................
d}...................f �'taOnsite Representative:,......We.spr................--. integrator: ......... t......... )...............................1.....h...-C..........
Certified Operator:-.-............................................................. Operator Certification Number:
Location of Farnt:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse . Latitude 0 4 •� Longitude • �44
Design Current
Swine Capacity POnalation
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Soars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer I I ❑ Dairy
❑ Non -Layer I I ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSL W
Number of Lagoons 1 ❑ Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
Holding Ponds / Solid Traps JEI No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed. did it reach Water of the State? (if yes, notify DWQ)
c. Il' dischargc is observed- what is the estimated flow in gal/min'?
& Does discharge bypass a lagoon system'? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & 'Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Su-ucturc I Structure 2 Structure 3 Structure 4 Structure S
Identifier: ...- ........... 11....... I .......... ....................................
Freeboard (inches):2
5100
❑ Yes )• No
❑ Yes J-No
❑ Yes &No
h /at
❑ Yes No
❑ Yes ff No
❑ Yes EgNo
❑ Yes No
Structure 6
Continued on back

f
Facility Number: 3/ — yO J Date of Inspection 23 Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑Yesj No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ® No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
IL Is there evidence of over application? ❑ Excessive Ponding gPAN ❑ Hydraulic Overload OYes ❑ No
12. Crop type e r r+-\ v(c, t-tc,y .rrncr) t G ra r r1
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
IT Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0: �Vo.viQlhti6iis ok- deficiencies were noted during this visit' - You Will-Teeeive iio: furth&
uorres�otrideizce: about this visit:: ' :::: : :
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
) / . Se,.erq ) ov - -r, fr I, (A-} s e 1-1 t o-/ BAN w e re kio+ed .
❑ Yes A No
❑ Yes 0 No
❑ Yes P No
❑ Yes P No
t4Yes ❑ No
❑ Yes No
ElYesNo
❑ Yes JN No
❑ Yes N No
❑ Yes 'JZ No
❑ Yes P No
19, F-i seat 3 avi M419 2's CS 6111res bQ� We4-4& ?I0I s4oL",s
,7.� atre5. AIs0� ri-e-1d q 0h mar 0)01A —FKf?_-1 S shoals /.��a(If esJ
b v 4 w a s�1e t hn s 4; �L Id $ �l -� y6�✓�4o4al %9 6. q r c s1. ; 13'%t k�
meth �ioYtS SvL1 410 �Ap =°�J� -Z� S� I Pid L-v4s_'e Play, ghee
1W
IReviewer/Inspector Name �- e ygL,ra j) I I
Reviewer/Inspector Signature:
Date: FIZ
5100

FaMity Number: ) — [�� a✓ Date of Inspection S Z3 DQ
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes 25�No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ONo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes RNo
roads, building structure, and/or public property)
24. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes Z No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes It No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ;TNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? [-]Yes KNo
AAditional.omtnents'an or .raw�ngs.
., A1
3/23/44

w w r Q p 'Aew
Division of Soil and "Water Conservation .:O eration Re w
13,
Division of Soil and;Water Conservation ;Compliance-1hspecti6i
DiAsiomof Water. ali Qu ty_ Compliance Inspection - _
r 11 Other Agency -'.00:criboii.Riview
Lq Routine Q Comnglaint Q Follow-ue of DWQ inspection Q Follow-up of DSWC review Q Other
Facility Number Date of Inspection
Time of Inspection 6:L7p 24 hr. (hh:mm)
C1 Permitted 13 Certified ❑ Conditionally Certified © Registered C] Not Operational I Date Last Operated: p • ..........................
FarmName: ..................Z-...............-............................................................................ County:.......i�4�1�i1....................................... ...............
Owner Name:...................xml..`....,. .. s..�04r..e,................................................ Phone No: ...�°li�.�..�.�(s -...�. �
l................................................
Facility Contact: ...........d. lyv,.......Vlf-.6.0 r........................ Title:.....................----....................................... Phone No:...................................................
FlailingAddress: .......�...�1.........�7C.....��........................... ........................................ ...........�Qs.1`.'.�GL,�..1...��f...................-........-...... ��Rg.........
........ ............... Q
Onsite Representative: lmm.v.......UCVak.................. integrator:..........la>�tiet1.`i.........................................................
.............. .......... .... .........................
Certified Operator: .... ; .............................................. .............................................................. Operator Certification Number:..........................................
Location of Farm:
Latitude Longitude
Design Current -:; Desi'Ciiiient
Srvtne Ca accity Population =Poultry. .'Capacity _ Population Cattle Capacity Population
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
® Farrow to Feeder.
7_00p
2-006
❑ Farrow to Finish
❑ Gilts,
❑ Boars
Tota1SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑Lagoon Area ❑ Spray Field Area
K- ..T._ .. ..
Holthng Ponds/ Solid.Traps ❑ No Liquid Waste Management System
_ :.:
Discharges & Stream Impacts
l . Is any discharge observed from any part of the operation? ❑ Yes P No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
h. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Identifier:
❑ Yes [� No
0
❑ Yes
No
f ! �®
— t�
❑ Yes
1� No
❑ Yes
ER No
❑ Yes
`P No
❑ Yes [I No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Freeboard (inches): ..........Z: ................ ..
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 20 No
seepage, etc.)
3/23/99. Continued on back

Q.
l Fa ,ity Number: 3 { - 4ol Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
$. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
❑ Yes
Q No
❑ Yes
M No
Yes
❑ No
❑ Yes
P No
❑ Yes
Da No
❑ Yes
(Z No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19_ Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
violaEmis:or• deficiencies Oitring 4bis:visit: • Y:oit :wilI-teaeiye Rio fui ftf
corresoii idence. about this visit. . . . . . .
Commentsz(refer.to:questionr#): Explain -any YES answers
Use,drawings of facility to better explain situations {use ad
- -.
:s o
Add
W tkk —.ntiy runc* . �3o i5cv e�
1�. aePn�ro. IRS- L fo,,-6 -sk04d b�
arid/or any-recommendations.'or any otherinm eoents:
diticnal'pages as necessary)
d O�ns�wcC� c�� �
IoA(-V- f l0k)' 0 f r s
Vkft for eC4 CYe � .
❑ Yes (P No
❑ Yes ® No
❑ Yes ® No
❑ Yes No
❑ Yes No
❑ Yes [d No
❑ Yes M No
❑ Yes R No
IYes ❑ No
❑ Yes No
❑ Yes No
❑ Yes 9 No
❑ Yes No
❑ Yes No
❑ Yes P9 No
ciS r- KSvit `
VPIVO_ Skoo lj b
Akdu5�_ S�6Akk"s-'
Reviewer/Inspector Name„ f
Reviewer/Inspector Signature:
Date:
3/23/99

'� F%Aty Number: Date of Inspection g �
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below 1�1 Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes JNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes [A)No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ERNo
32.' Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes [QJ No
_ _ _. Oonal Comments:and/orDrawings: e _
0
3/23/99

h _
❑ Division of Soil and Water Conservation ❑ Other Agency
KrI
Division of Water Quality �"'
Routine 0 Complaint 0 Follow-uE of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number
Date of Inspection $' f
p
Time of Inspection �24 hr. (hh:mm)
Registered IP Certified © Applied for Permit P1 Permitted j13 Not O erational I Date Last Operated:
K- L County:........ ........ Farm Name:.......................................................................................................
Owner Name; p
&a h.......... dT!`.fcrt21.i1�►_. ........................................... Phone No: ..... ��(,�l�.Zri(�..�i�P..
FacilityContact: ............... .! ..p�......Vsnmr.s....................... Title:................................................................ Phone No:.....................................-----.........
MailingAddress:..............:? G........5�:?4 Y.... IV................................................................... ....... W.0a..S.A'i...... .......................................... ..�g3.`t�'........
OnsiteRepresentative: ........ ,........ ,x.............................................................. Integrator:..............................................................
Certified Operator;............................................................................................................... Operator Certification Number;......--.--- ............................
Location of Farm:
1�tr....riA ...... .... ��..4........ ...i �.....�....rnt:�n.....SA.. i�...Q. ... .R..� t?lv.............................................................................................. A
.......... ....... .. ........................ ............... ......... ......
Latitude �• ' �" Longitude �• �' �"
n� Desrgrr� Currint Design CurrenE E Design CurreQE
;r
SYwtne Capacity Popular;on Poultry ;Capacity, Population Cattle Capactty Popula€ron F.
❑ Wean to Feeder JE1 Layer ❑ Dairy
[IFeeder to Finish ❑Non -Layer ❑Nan -Dairy
❑ Farrow to Wean ` P
m
❑ Other'
® Farrow to Feeder z000
r:
❑ Farrow to Finish Total Design.Capaci.
❑ Gilts
❑ Boars x . Total SSLW
NWkh& of oons / Hai `Ponds ' ! ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
.........
4 AM ❑ No Liquid Waste Management System
F �.$
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
No
2. Is any discharge observed from any part of the operation?
❑ Yes
No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
JM No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
No
c. If discharge is observed, what is the estimated flow in gallmin?bilk
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
® No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
l No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
M No
mai ntenancelimprovement?
6- Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
® No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
0 No
7/25/97

Facility Number: �) —
8.
Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
;& No
Structures (La2oonsjlolding Ponds, Flush fits, etc.)
9.
Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
W No
Structure l Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Freeboard(ft): ............ :......................................................
10.
Is seepage observed from any of the structures?
❑ Yes
No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
® No
12.
Do any of the structures need maintenance/improvement?
Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
H) No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
10 No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type ...........................Sm. Pj\......Q fk,hr ............................ .
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
UNo
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
rUNo
18.
Does the receiving crop need improvement?
Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
Co No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
1% No
22.
Does record keeping need improvement?
(A Yes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
1V No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
M Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Permit?
ED Yes
[I No
[].No.violatioins.or deficiencies were noted- during this.VisiC, You:will iecei:ve•n6 furtlier
Orrt sp00dence about this: visit:::: ,
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7/25/97
Reviewer/Inspector Name
WM
Reviewer/Inspector Signature:—
,
j L 1_
Date: 111 1
j

❑ DSWC Anibal Feedlot Op - era ew
n l:
s = ®D,WQ Animal Feedlot:46eration Site.Ynspection n
t
•
'' •� Routine O Complaint O Follow-upCV
of DO inspection O Follow-un of DSWC review O Other
Date of Inspection i
Facility Number 3 ! Time of Inspection Lo : Q Use 24 hr. time
Farm Status: -?� �{ � Total Time (in hours) Spent onRe-szew
or Inspection ('includes travel and processing)
Farm Nacre: ,�a z — z County: Duf k vq- - -
Owner Name: - -_ Phone No: (9) D I Z 9 T - z 6 DO
f
Mailing Address:
Onsite Representative: Integrator:.9r=mVL---.-
Certified Operator: Operator Certification Number. - %_7.
Location of Farm:
Latitude 11u Longitude 7�• 0 j ' ©"
❑'Not Operational I Date Last Operated:
- rspe of Operation and Design Capacity
Srrcne K �..': -., _ Number'> - otiltry_ �~ \tcmber :; Caftie s Dumber
- _
❑ Wean to Feeder
7M ❑ Laver
` ❑ Dairy
'_
❑ Feeder to Finish
n
kN � - ElNon-Laver__,
a
jw; ❑ Beef
Farrow to Wean
"'
S K s
M -
Farrow to Feeder
J..x'x-.w .+'i!
0z
,
Farrow to Finish
K',[❑ Other Type of Livestock
+;'�""�-�'( 34±" _ � 4Ge."rY. .+°4 �+�. "2�X'.'..�..�'�'.r`-e �� 'w6, y--`�":3e & :.-;g .{'sC= <.rtY..'t :A %' ✓'
'Number of Lagoons f HoldtngPonds` F ❑ Subsurface Drains Present
❑ Lagoon area ELI Spray Field Area '
General
I. Are there any buffers that need maintenance/improvement? ❑ -Yes 0 No
2. Is any disc: ar-ge observed from any part of the operation? ❑ Yes ENO
a- If discharge is observed, was the conveyance man -trade? ❑ Yes ® No
b. If discharge is observed, did it reach Surface Water? (If yes, notiry DWQ ❑ Yes Q No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes No
Is there evidence of past discharge from any part of the operation? El Yes �f No
4. Was there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes ®No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes 0 No
rr :inteaancerimprovemcnt•?
Continued on hack

6. Is facility not in compliance with any applicable setback criteria?
7. Did the facility fail to have a certified operator in responsible charge (if inspection niter 111197j?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Laepons and/or Holdin�Ponds�
9. Is structural freeboard less than adequate?
Freeboard (ft): Lagoon 1 Lagoon 2 Lagoon 3
Z 1
10. Is seepage observed'from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adquate markers to identify start and stop pumping levels?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type-
16. Do the active crops differ with those desig=ted in the Animal Waste Mana;ement Plan?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the cover crop need improvement?
19. - Is there a lack of available irrigation equipment?
For Certified Facilities Ooly-
20. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
21. Does the facility fail to comply with the Animal. Waste Management Plan in any way?
22. Does record keeping need improvement?
23. Does facility require a follow-up visit by same agency?
24. Did Reviewer/Inspector fail to discuss review/inspection with owner or operator in charge?
❑ Yes , ® No
❑ Yes 21 No
❑ Yes 2 No
❑ Yes ENo
Lagoon 4
❑ Yes
9 No
❑ Yes
I&No
❑ Yes
KNo
❑ Yes
ER No
❑ Yes
RNo
❑ Yes ®No
❑ Yes ® No
❑ Yes B No
❑ Yes IR No
❑ Yes HNo
.Yes ❑ No
0 Yes ❑ No
❑ Yes igNo
❑ Yes IRJ No
Cazrtinenis prefer to questFoi%� Explatn ariyYFS answersanalor any recaraunciadatFans or nay other coiiimertEs e u r
.ss., .'-fi.�, i�'*,��"^F ` .�a�c...�t::m..«xi4"a C'.." ;i3«.-.xas +c"•�' sakssr�.' �t4..Y'sr�.r'-s'�".r.'3:a�t..e'.rc�a� H°r'-"".""' �a?,r-�`�".s� +x"q- � a S
UTsc drawings :of fty to better exIaFn sttuatFOFis= use addFuanal•pages as net es } k„�.I
D eA,,X r, a 1-9 L-s (p o 4 1. s... s, w enrQ o 6-1 en ue4— .. 4 t i � 0-0 vV a- L +-1-14m e of Q
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A r,.. a reed-S �ba 6 e i �.. c 1 u d Q-d i .� 4, e a r••4 a! w a s f-� a „t. o q e �,.R t P Q
t11ab �ti,-nwt tv's 044cit'i �4-Q-VC, r.0 be,r�I r t�•� toct liE
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w. t 1n f w o o i- l 4 `^ E
keg U d oK ol.@ a" 100jC.
Ke C-CL-1 w 0.1-f-
Reviewer/Inspector Name`.;'=
Reiiwer/Inspector Signature: a _! _ o .. Y _ o Date: 5 j C/ g 7
cc: Division of Water Quality, Water Qualify Secrion, Facility Assessment Unit . I t/I4/96

L.
C
Site Requires Immediate Attenti :
-Ah—
Facility No. �
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATION SITE VISITATION RECORD
DATE. �'3 , 1995
. Time:
Farm No
Mailing
County:
Integrate
On Site
Physical
Type of
Design Capacity: _0Cr17 - - Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 3 `t`/° S6 ' 013 Longitude: V Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches(Ye r No Actual FreeboarP d- Ft. _6_ Inches
Was any seepage observed from the laaoon(s)? Yes No Was any erosion observed? Yes
. �es Is adequate land available for sprallo Is a cover crop adequate? Yes or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwelling Yes r No
100 Feet from Well . es No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of a state by man-made ditch, flushing system, or other
similar man -dude devices? Yes r No If Yes, Please Explain.
Does the facility maintain adequate w e management records (volumes of manure, land applied,
spray irrigated on specific a�cr�ese with. cover crop)? Yes or No
Additional Comments: L 1
Inspector Name
cc: Facility Assessment Unit
Si
wk<
Use Attachments if Needed.