310039_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

/,
_Facility Number Division of Soil and"WaterConservat,on,
Type of Visit: fQ Cance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: Routine O Complaint Q Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: 2P Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: //�� Title: Phone:
Onsite Representative: AN( C kK C A/„rr, S Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number: 1 rS 9 t-s-
Certification Number:
Longitude:
F,�
a `"3ri
Design Current•. Desi n Current~ "_
. gn g �--� �� ; � �� �, Design i Gnrrentf ;-
Swme Capacity. -= Pap:' � Wet Poultry Capacity Pop Cattle Capacity .Pap
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
row to Finish
tsars
L
k:
Turkeys
Other Turke Pouits
Other Other
La er g
Non -La er I�`-
Design Current w'
Di `.Point I', Ca acePo
Layers
Non -Layers
Pullets
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
0 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?
❑ YesgNo5�
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[—]Yes
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Faciii Number: 2 f - jDate of Inspection: 9
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [ o_ ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ 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
(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 2/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 VN9.
N ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes M No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP [:]Checklists ❑ Design [:]Maps [:]Lease Agreements
❑ Yes
ff ❑ NA
o
❑ NE
❑ Yes
❑� ❑ NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
❑ Yes
VN ❑ NA
❑ NE
❑ Yes
'N ❑ NA
❑ NE
❑ Yes
6No ❑ NA
❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [:]Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes LfNo
o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [3 Yes ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facilk 'Number: IDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes C; F 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 provide documentation of an actively certified operator in charge? ❑ Yes No YNA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? '
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31.. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Comments (refer to questlon #):.Explain any VES answers and/or'any`additional reeomrnei
Use d%_awrugs offacility-=to-better=eigplam sltuitrons,(use=addit,onal,pages asmecessary):, , a .
s4�
0),;5 t 5rt �'OL�
❑ Yes No ❑ NA ❑ NE
❑ Yes ErNo
❑ Yes No
❑ Yes � No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ Yes o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
2v��
���� Refit
-., 4-� -� -�- i ^� H c, I ( (14 ) ra A
Reviewer/Inspector Name: D a'." ! d
Reviewer/Inspector Signature:�`�
Page 3 of 3
Phone: 1/0 79i7ao
Date: T Z y/ r 7
21412015

Waters Agricultural Laboratories, Inc.
kc• 364 West Park Drive Warsaw, NC 28398 257 Newton Hwy - P.O. Box 382 i
[phone] FAX [phone] Camilla, Georgia 31730 iii6o
[phone] FAX [phone]
SMITHFIELD L&N DEPT Soil Analysis Report Grower: PO 1386332 Account#: 435
PO BOX 856 Received: 6/6/2017
NCDA Index Field ID: BENSON WARSAW, NC 28398 Processed: 6/8/2017
water ❑
Lab Nu0 ._�mber Sample ID P•I K-I Mg°� Ca% pH Ac 5 I Zn-I Zn-AI Mn-I Mn-AI Cu-I CEC BS% HM% Soil Class
813415UW 5A 245 83 12.6 , 57.9 6.2 , 0.8 , 12 , 484 , 484 37 37 255 4.1 , 80.6 , 0.42 , Min
Recommendations - Ibs./A
Crop MILO
Lime-TonslA
0.0
QN
100
P205
0
K20
0
�
0
I!]
20
0
0
1Zn
0
®
Mn
See Note
3
813416UW 56
!Recommendations
247 76
9.6
55.2 6
1.0
13 389
389
50
48
213
3.9 74.5
0.43 Min
- Ibs./A
Crop MILO
0.0
100
P2O5
0
K20
20
25
0
20
Cu
0
Zn
0
©
Mn
See Nate
3
813417UW 6A
236 79
12.6
50.5 6.1
1.0
13 399
399
37
38
219
3.8 73.5
0.36 Min
Recommendations - Ibs./A
Crop MILO
Lime Tons/A
0.0
N[]
100
P205
0
K20
20
W
❑S
20
Cu
0
Zn
0
©
Mn
See Nate
3
813418UW 66
305 92
10.8
58.5 6
1.0
15 491
491
62
54
259
4.8 79.0
0.44 Min
Recommendations - Ibs.IA
Crop MILO
0.0
100
P205
0
K20
0
M®
0
❑S
20
Cu
0
Zn
0
©
Mn
See Note
3
813419UW i LG1
!Recommendations
90 39
8.4
22.9 4.1
4.0
63 146
146
25
24
81
6.1 34.6
0.36 Min
- Ibs./A
Crop BERMUDA Pasture M
3.1
220
P22 075
0
K20
140
M®
0
❑S
0
Cu
0
Zn
0
�B
Mn
See Note
12
Fertilizer recommendations are based on the philosophy and recommendations of the NCDA Agronomic Division
DWQ Laboratory Certification Number 636

r
` Waters Agricultural Laboratories, Inc.
364 West Park Drive Warsaw, NC 28398 257 Newton Hwy - P.O. Box 382 $ c
[phone] FAX [phone] Camilla, Georgia 31730
4W [phone] FAX [phone]
Soil Analysis Report
Grower: PO 1386332
Account#:
435
SMITHFIELD L&N DEPT
PO BOX 856
NC DA Index
Field ID: 13ENSON
Received:
6/6/2017
WARSAW, NC 28398
Processed:
6/8/2017
Lab Number Sample ID
P I K-I Mg% Ca%
� ❑ ❑ ❑
r
Water
Ac S I Zn-I Zn-AI
❑ ❑ ❑ ❑
Mn-I Mn Cu-i
❑ ❑� ❑
CEC BS H
❑ ❑ ❑
Soil Class
813407UW 1A
56 34 15.2 46.4 6 1.0 16 84 , 84
34 38 27
3.1 67.2 0.52
, Min
Recommendations - Ibs./A
Crop MILO
0.0
100
P7205
20
K20
70
Mg]
❑S
20
Cu
0
Zn
0
©
Mn
See Note
3
813408UW 1 B
174
76
12.7
40.3 5.8
1.6
15
197
197
31
36
134
4.2
62.1
0.45 Min
Recommendations - Ibs./A
Crop MILO
Lime TonslA
0.4
❑N
100
P205
0
K20
20
M®
0
❑5
20
Cu
0
Zn
0
�B
Mn
See Note
3
813409UW 2A
212
78
10.8
42.9 6
1.5
14
313
313
31
35
213
4.3
62.8
0.50 Min
Recommendations - Ibs./A
Crop MILO
0.0
100
P2205
0
K20
20
M®
❑S
20
Cu
0
Zn
0
®
Mn
See Nole
3
f 813410UW : 2B
f
266
99
10.5
47.1 - i 5.9 1.4
14
426
426
34
37
282
4.5
68.7
0.48 Min
Recommendations - Ibs./A
Crop MILO
ume TonslA
0.3
[]N
100
P205
0
K20
0
M®
❑S
20
Cu
0
0
jSee Note
3
813411UW ; 3A
237
57
11.2
43.1 5.6
1.4
15
233
233
21
22
169
3.7
62.2
0.60 Min
Recommendations - ibs./A
Crop BERMUDA Pasture M
Lime-Tons1A
0.6
❑N
2-20
P205
0
K20
100
M®
S❑
20
Cu
0
Zn
0
®
Mn
See Note
12
613412UW 3B
237
57
12.9
40.5 5.7 1.8
16
241
241
21
22
157
4.5
59.8
0.61 Min
Recommendations - Ibs./A
Crop BERMUDA Pasture M
0.6
220
P7205
0
KZO
100
M®
0
[k]
20
Cu
0
Zn
0
©
Mn
ISee Note
12
813413UW 4A
362
130
9.9
44.2 5.9
1.4
20
568
568
21
22
514
4.5
68.7
0.62 Min
Recommendations - Ibs./A
Crop BERMUDA Pasture M
Lime-TonslA
0.3
❑N
220
P205
0
K2Q
0
M®
25
❑S
20
Cu
0
Zn
0
®
Mn
See Note
12
813414UW 413
247
54
18.2
49.5 6.2
1.1
16
361
361
21
27
342
4.6
73.7
0.57 Min
Recommendations - Ibs-1A
Crop BERMUDA Pasture M
Lime Tons1A
0.0
nN
220
P205
0
K20
100
0
0
20
Cu
0
Zn
0
©
Mn
See Note
12
Fertilizer recommendations are based on the philosophy and recommendations of the NCDA Agronomic Division
DWQ Laboratory Certification Number 636

E Division of Water Resources
❑ Division of Soil and Water Conservation
❑ Other Agency
Facility Number.
310039 Facility Status:
Active Permit: AWS310039
❑ Denied Access
Inpsection Type:
Compliance Inspection
Inactive Or Closed Date:
Reason for Visit:
Routine
County: Duplin Region.
Wilmington
Date of Visit:
03/27/2015 Entry Time: 01:00 pm
Exit Time, 2:00 pm Incident g
Farm Name:
Benson Farm
Owner Email:
Owner;
Murphy -Brown LLC
Phone:
910-295-1800
Mailing Address,
PO Box 487
Warsaw NC 28398
Physical Address:
Sr 1307 956 Veaches Mill Rd
Warsaw NC 28398
Facllity Status:
❑ Compliant ❑ Not Compliant
Integrator. Murphy -Brown LLC
Location of Farm:
Latitude. 35' 03' Longitude:
77" 59' 52"
West of Westbrook Crossroads. On North side of SR 1307 approx. 3.4 miles West of SR 1004
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 Represen ative(s):
Name
Two 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:
page: 1

Permit: AWS310039 Owner - Facility: Murphy -Brown LLC Facility Number: 310039
Inspection Date: 03/27/15 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Waste Structures
Dlslgnated Observed
Type Identlfler Closed Date Start Date Freeboard Freeboard
Lagoon BENSON 22.00 34.00
page: 2

Permit: AWS310039 Owner - Facility: Murphy -Brown LLC Facility Number: 310039
Inspection Date: 03/27/15 Inssection 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?
❑
M ❑
❑
b. Did discharge reach Waters of the State? {rf yes, notify DWQ)
❑
M ❑
❑
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑
0 ❑
❑
2. Is there evidence of a past discharge from any part of the operation?
❑
E ❑
❑
3. Were there any observable adverse impacts or potential adverse impacts to Waters of the
❑
E ❑
❑
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 (I.e./ large
❑
❑
❑
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a
❑
❑
❑
waste management or Bosun: plan?
7. Do any of the structures need maintenance or improvement?
❑
❑
❑
8. Do any of the structures lack adequate markers as required by the permit? (Not applicable
❑
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 Ne
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ 0 ❑ ❑
maintenance or improvement?
11. Is there evidence of incorrect application?
❑ 01111
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
❑
PAN?
❑
Is PAN > 10%/10 Ibs.?
❑
Total Phosphorus?
❑
Failure to incorporate manuretsludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
page: 3

' ' Permit: AWS310039 Owner - Facility: Murphy -Brown LLC Facility Number:
Inspection Date: 03/27/15 Inpsection Type: Compliance Inspection Reason for Visit:
310039
Routine
Waste Application
Y"
Ng Na N,q
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
❑
0 ❑
❑
determination?
17. Does the facility lack adequate acreage for land application?
❑
E0
❑
18. Is there a lack of property operating waste application equipment?
❑
0 ❑
❑
Records and Documents
Yea No No
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑ 0 ❑ ❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑ 0 ❑ ❑
If yes, check the appropriate box below.
WUP?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Lease Agreements?
❑
Other?
❑
If Other, please specify
21. Does record keeping need improvement?
❑ 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: AWS310039 Owner - Facility: Murphy -Brown LLC Facility Number. 310039
Inspection Date: 03/27/15 Inpsecton Type: Compliance Inspection Reason for Visit: Routine
Records and Documents
Yes
No Na Me
Crop yields?
❑
120 Minute inspections?
❑
Monthly and 1" Rainfall Inspections
❑
Sludge Survey
❑
22. Did the facility fail to install and maintain a rain gauge?
❑
M ❑
❑
23. If selected, did the facility fall to install and maintain a rainbreaker on irrigation equipment
❑
❑
❑
(NPDES only)?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
M ❑
❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check the
❑
❑
❑
appropriate box(es) below:
Failure to complete annual sludge survey
[]
Failure to develop a POA for sludge levels
❑
Non -compliant sludge levels in any lagoon
❑
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑
M ❑
❑
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
0 ❑
❑
Other Issues
Yes
No Na Me
28. Did the facility fail to property dispose of dead animals within 24 hours and/or document
❑
M ❑
❑
and report mortality rates that exceed normal rates?
29. At the time of the inspection did the facility pose an odor or air quality concern? If yes,
❑
0 ❑
❑
contact a regional Air Quality representative immediately.
30. Did the facility fail to notify regional DWQ of emergency situations as required by Permit?
❑
0 ❑
❑
(i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility?
❑
0 ❑
❑
If yes, check the appropriate box below.
Application Field
❑
Lagoon / Storage Pond
❑
Other
❑
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or
❑
0 ❑
❑
CAWMP?
33. Did the Reviewerftspector fall to discuss reviewfinspection with on -site representative?
❑
0 ❑
❑
34. Does the facility require a follow-up visit by same agency?
❑
0 ❑
❑
page: 5

ivision of Water Quality
Facility Number � - � O Division of Soil and Water Conservation
O Other Agency
Type of Visit: • ompliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Qlkoutine O Complaint O Follow-up O Referral O Emergency O Other �0 Denied Access
Date of Visit: Arrival Time: Departure Time:County:�/i(j�/ Region:
Farm Name: n Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: ��%%I S Integrator: m ,%; T
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Swine
mean to Finish
Jean to Feeder
eederto Finish
arrow to Wean
arrow to Feeder
arrow to Finish
Other
Other
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La er
Discharges and Stream ImFacts
Non-L
Pullets
TurkeN
Other
Poults
Design Current
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
1. Is any discharge observed from any part of the operation?
❑ Yes Z No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ YesNo
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ YesNo
// ``''
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes 4,
❑ NA
❑ NE
No
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes eNo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued
1\

y. r , }� .•. f ,'� —.�ti. '., a . „f J• 40V,.7 -e^r' .T 7 - °-t j . » - e
7 ,n }t`�. .1; � 4 fi t 'F •. t,. ..r., ,3• K '
Facitty Number O Division of.Soil and Water Conservation
. •�. Q Other Agency
lReason.for Visit:
` Date of visit:
4
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
e Inspection O Operation Review O Structure Evaluation O Technical Assistance I
O Complaint O Follow-up O ReferralO Emergency O Other O Denied Access
Arrival Time: Departure Time:
County: // Region:
Q✓� Owner Email:
Phone:
Facility Contact: Title:
OnsiteRepresentative: irhgy/ &&(a5.
r
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean 'to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Soars
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Design Current
Wet Poultry Capacity Pop.
Layer I :F�
[Non -Layer
Pullets
Design Current
Longitude:
Cattle
Design Current
Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non-Dai
Beef Stocker
Beef Feeder
Beef Brood Cow
" Discharges and Stream Impacts
' 1. Is discharge from
Yes f No
NA
NE
any observed any part of the operation?
❑ 2
❑
❑
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)
❑ YesNo
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes �No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes /❑ No
❑ NA
❑ NE
,z 3. Were there any observable adverse impacts or potential adverse impacts to the waters
c-
❑ Yes eNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued
ryx. .. `,. .�. .> •: uF,: a^r«r z_I � .,. —s. •t'�t: o-: � fi. :sir � '' f,^t . _�. - ��.� �� - . �i � � . � .,u . �t -�.

Facili dumber: - 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 ❑ 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 eFe�o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes XfNo ❑ 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,,ffNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes /ffNo ❑ 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 ,E5 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes .fNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes f!fNo ❑ 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 4Eff'No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes E:rNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [] Yes ErNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes )21'No ❑ NA ❑ NE
❑ Yes EffNo ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ,�TNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E:J"No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other;
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ,EfT—No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes f7fNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes dNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facili :,lumber: jDate of Inspection:
Waste, Gollection &Treatment
w4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA 0 NE
.� a. If yes, is waste level into the structural freeboard? ❑ Yes E f 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
(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 ,FfNo ❑ 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,4ETNo ❑ NA ❑ NE
S. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ff No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
Y9. Does any part of the waste management system other than the waste structures require ❑ Yes .,ETNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ,:jNo ❑ NA ❑ NE
maintenance or improvement?
I I- Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E!fNo ❑ NA ❑ NE
+ 0 Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑Failure to Incorporate Manure/Sludge into Bare Soil
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus
a
❑ 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 AE 'No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ,ETNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [DNo ❑ NA ❑ NE
r ' ` acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes 0 No
❑ NA
❑ NE
_
18. Is there a lack of properly operating waste application equipment?
❑ Yes ',rNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes ,E]No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes ETNo
❑ 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 {D-No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge �Survcy
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 dNo
[] NA
❑ NE
Page 2 of 3 21412011 Continued
._.w...R�. .._.. _>�.• ii .. ar_. �.. _. -.. .. �A i. :•. '.1 t.. ... _ i - __•

Facili Number: - Date of Inspection: p
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ErNo ❑ 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 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes,,ONo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes Ef No [] NA ❑ NE
❑ Yes ZrNo ❑ NA ❑ NE
❑ Yes,,ETNo ❑ NA ❑ NE
❑ Yes r} o ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes allo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss reviewlinspection with an on -site representative? ❑ Yes ,❑'No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes El No ❑ NA ❑ NE
Comments (refer to question #1): 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:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: t ,
Date: / -3 o?oht
14120 1

y^ ,,y.: ii i.' �'{,. ...-"l•f �:,. -• -r. -raF• .. t,.. , ,:�s:•ec. •:-a r _ ar• ,
Facility Number: Date of Ins ection:
,. •24. Did tie 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 ,EjNo ❑ NA ❑ NE
tthe appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
t ❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes,.[]] No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes J`No
' 33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes EyNo
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ No
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other
Use drawings of facility to better explain situations (use additional pages as necessary).
i
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
[:]Yes ,-No ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes,,allo ❑ NA ❑ NE
❑ Yes PI -No ❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑NA ONE
comments.
Phone:��%�/��(�
Date: -1C2 V
21412071

'-)Q Division of Water Quality
Facility Number 3 O Division of Soil and Water Conservation
O Other Agency - .• ..
Type of Visit Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit .04outine Q Complaint O Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: i parture Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: /-�%G C�f�✓�
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
Other
❑ Other J
Owner Email:
Phone:
Phone No:
Integrator•
Operator Certi �lcation Number:
Back-up Certification Number:
Latitude: ° Longitude: °
Design Current
Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
Ell
❑ Other
1
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
Design'.Current, 5
Capacity Population ;
❑ Dai Cow
❑ Dairy Calf
❑ 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? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes O'No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
ZI No
❑ Yes
P 'No
❑ NA
❑ NE
❑ Yes
q 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
�o [I NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[KNo ❑ NA
❑ NE
St lure I Structure 2 Structure 3 Structure 4
Structure
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
S. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
7No ❑ 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
INo ❑ NA
❑ NE
8. Do any of the stuctttres lack adequate markers as required by the permit?
❑ Yes
qi 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
VNo ❑ 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
�rNo ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)
❑ FAN ❑ 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?
❑ YesV/No
El NA
El NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
E; No
//KNo
El NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination`: ❑ Yes
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
2fNo
❑ NA
❑ NE
19. Is there a lack of properly operating waste application equipment?
❑ Yes
C/No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Urr. 101 Phone:
Reviewer/lnspector Signature: Date: 3
12/28/04 Continued

Facility Number: — Date of Inspection 3
ReQuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes FfNo ❑ 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 El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0No ❑ 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
VNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
XNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�dNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ZNo
❑ 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
KNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
J jNo
❑ 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
5dNo
❑ 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
efNo
❑ 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
PNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

0 Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
O Other Agency w
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: / Arrival Time: iJUAMWrture Time: County: ' /V Region: C2!%�IF
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: r �'
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity -Population
I
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
[E]Boars
Other
❑ Other _
Owner Email:
Phone:
Pl ne No:
Integrator
Operator Certifilation Number:
Back-up Certification Number:
Latitude: 0 c= 4= Longitude: = c 0 6
Design Current Design Current . I
Wet Poultry° Capacity Population . Cattle ' "';Capacity , -I opelation
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures: I fl
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
El Yes
El No
El NA
El NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
El NE
❑ Yes
P,No
El Yes
K o
❑ NA
❑ NE
ElYes
Zo
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
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?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes V,40 ❑ NA ❑ NE
❑ Yes !Q No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 110 ❑ NA ❑ NE
❑ Yes gNo ❑ 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 ,ZNo ❑ 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 El Yes [No El 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 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
XN o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
No
❑ NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
El NA
El NE
17. Does the facility lack adequate acreage for land application?
ElYJ Yes
,V1No
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
;2/No
❑ NA
❑ NE
Comments (refer to question ##): Explain any YES answers and/or any recommendations or any other comments.,.
Use drawin s of facility to better explain situations. use additional pages", 'a'snecessa y)�
Reviewer/inspector Name Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 121AI04 " Continued

Facility Number: 31 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 ZNo ❑ 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 ZNo ❑ 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 ,ZNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El Yes l,�No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes PNo ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes No ❑ 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 PKo ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes gNo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes IVNo ❑ 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 P(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 0"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 �ONo ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes o ❑ NA ❑ NE
Additional Comments and/or Drawings:
d Y G/ l H
Page 3 of 3 12128104

Division of Water Quality
• Facility Number 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 9XI10'mpliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit 2±utine 0 Complaint Q Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access'' �
Date of Visit: Arrival Time: Q arture Time: County: _.;0�Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: PhoneNo:
Onsite Representative: �� ! �^ Integrator: //' I �(
OF
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: u [—] ' = « Longitude: = o
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Soars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
I 1❑ La er
[-]Non-Layei
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: F7
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 PNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
12128104 Continued

Facility Dumber: �' Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes AI
o [I 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
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes dNo
❑ 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 ❑.io
❑ NA ElNE
8. Do any of the stuctures lack adequate markers as required by the permit? ElYes //O 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 ON.
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 1 o
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes P3 No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
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
L/J No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
UNo
❑ 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
[lo
❑ NA
❑ NE
Comments,(refer�to queshon #) ;Ezpla�n"aoy�YESanswers and/or any recommendations or any other comments.
Use drawtngsof factlttyet#er-explain�st a�han (useaddttonalpageasnecessaryf):
�a w
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date: O
Pape 2 of 3 12/2 /04 Continued

Facility Number: Date of Inspection
r-
Reauired 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 dNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design
g El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes PNo ❑ NA ElNE
ElWaste Application ❑ Weekly Freeboard ❑ Waste Analysis ElSoil Analysis [IWaste 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
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
2fNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
[I NA
[I NE
26. Did the facility fail to have an actively certified operator in charge?
El Yes
_[
L� 0
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ZNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ NA
[:INE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
,VNo
ILI 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
VNo
❑ 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
UfNo
❑ 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?
❑ Yes
No
❑ NA
❑ NE
Page 3 of 3 12128104

Facility Number
_10�,Oivision of Water Quality
Q Division of Soil and Water Conservation
0 Other Agency
Type of Visit Q Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: 6 L Arrival Time:Departure Time: County: Region:�
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 6117�^
Certified Operator:
Phone No:
Integrator•
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Latitude: = o = d Longitude: = ° 0 =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
I_� ❑ Non -La ei
Other
❑ Other - - -
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
aiurkey 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
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
l
❑ Beef Feeder
❑ Beef Brood Co
I
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes JZNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
ZNo
❑ Yes
j2No
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
12128104 Continued

Facility (Number: -&Z I Date of Inspection 6
Waste Collection —&� Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �dNo El NA El NE
a. If yes, is waste level into the structural freeboard? ElL( 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 . PNo ❑ 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 1;1'No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes �'N
o❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ 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 El NA ❑ NE
El Excessive Ponding El Hydraulic Overload ❑ Frozen Ground El Heavy Metals (Cu, Zn, etc.) //
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes 0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[PNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
[ YNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[ZNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Z�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 - Phone:
Reviewerl[nspectar Signature: Date:
12128104 Continued

Facility Number: Date of Inspection 6
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ;3 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [;KNo ❑ NA ❑ NE
the appropirate 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 V 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
(FNo
Cl NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�TNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
PrNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
�kNo
❑ NA
ElNE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
VNo
❑ NA
❑ NE
Other Issues
2& Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Z(No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
dNo
❑ 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
VN o
❑ 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
[;YNo
❑ 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
,�(
L�J No
❑ NA
❑ NE
12128104

vision of Water Quality
Facility Number ( t O Division of Soil and. Water Conservation
Q Other Agency
E
of Visit Compliance Inspection Q Operation Review O Structure Evaluation O Technical Assistance
on for Visit�'Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: f. Arrival Time: Departure Time: County: � Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
❑ Wean to Finish
❑ Wean to Feeder
13Teeder Finish
L220
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other.. -
Owner Email:
Phone:
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Latitude: [—] c [::]' E::] Longitude: [� o
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ 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
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stockei
❑ 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 ❑ No ❑ NA ❑ NE
❑Yes
El No
El NA
El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ NE
El Yes
[I No
El NA
El NE
12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Stru re 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 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
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):
&4 ��ra�/ l� Sn4eel7veeoleo y �d
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date: 4�
Page 2 of 1112810 Continued

Facility Dumber: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists El Design El Maps [I 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:. 1
12128104

�� � Division of Soil and Water C6nservat o
'acithi Nuim6er
��•ux�a� TIT —
Type
Type of Visit compliance Inspection 0 Operation Review 0 structure Evaluation 0 Technical Assistance
Reason for Visit routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Ji Arrival Time: Departure Time: � County: L/�_ Region4���
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
❑ Wean to Finish _
❑ Wean to Feeder
eeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Phone:
Phone No:
Integrator: �'ad s-•
Operator Certification Number:
Back-up Certification Number:
Latitude: [= o = f 0 « Longitude: 0 ° =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population Cattle
Other
❑ Other - - — — — - --
Non-
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Putlets
❑ Turkeys
❑ urkey 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
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
I
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Humber 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 (Ko ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
u o
❑ Yes
ElNA
ElNE
�$o
ElYes
No
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection 6
Waste Collection & 'Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes JC IKo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes_,;�No ❑ NA ❑ NE
Structure l 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 Aallo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes,-E]�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 ❑lqQ
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Lj'lto ❑ 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 [I Yes r-1 -Nlo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 9-no ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 1_E]-1qo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ 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 &INo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes L2-No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination:
❑ Yes 9Fo
❑ NA
❑ NE
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 Q No
❑ NA
❑ NE
17
Reviewer/Inspector Name Ij!!jelr ,_ Phone:
Reviewer/Inspector Signature: Date: 97e p
1212814 Continued

Facility Number: :.3 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes P No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes )2 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑-Wo ❑ 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 P No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
PINo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[,DNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
P*o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑'No
❑ NA
❑ NE
No
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
O
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
;:jNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
I
❑ 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?
El Yes
,[,/
E 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
eo
❑ 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
,Ej.No
❑ NA
[INE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑)(o
❑ NA
❑ NE
Additional Comments and/or Drawings:
Z,
a? /,, /l
s /j/d fQ j
a 9 G y 8
�F Czh n p 21fUw �% o /'
/,Syp
wo/6 rrz s •mar �l�S
C � �
-e;f t— C64e
to��Y
12128104

Type of Visit &Compliance Inspection 0 Operation Review 0 Lagoon Evaluation I
Reason for Visit ffi Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of Visit:
ELPermitted Cefirtied [3 Conditionally Certified [3Registered
Farm Name: &SDn T `i-,A _
Owner Name:
Mailing Address:
Time:
Date Last Operated orbove Threshold: _
County:
Phone No:
Facility Contact: Title: �Phone No:
Onsite Representative: f dY �i'i°9 integrator:
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 4 r—�" Longitude 0 4
Design Current
awiur
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons
Holding Ponds I Solid Traps
Design Current Design Current
Poultry Capacity Population Cattle Capacity Po ulation
❑ Layer I I ❑ Dairy
❑ Non -Layer I 1 10 Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Discharas & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 9 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated Flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes KNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 1No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 91 No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
05103101 Continued

Facility Number: — 3q Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 1�1 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 9 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 RNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes �4No
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 In No
11. Is there evidence of over application? /❑ Excessive Ponding ❑ PAN / ❑ Hydraulic Overload ❑ Yes t9 No
12. Crop type &genm
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 R.No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
t5. Does the receiving crop need improvement? ❑ Yes IT] No
16. Is there a lack of adequate waste application equipment? ❑ Yes 29 No
Reauired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
OSNo
18_
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.)
❑ Yes
No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
%No
22
Fail to notify re ional DWQ of emergency situations as required b General Permit?
g y
(ic/ discharge, freeboard problems, over application)
❑ Yes
0 No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
U No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
V) No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
MNo
©
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
wis fir' is> :=_ ,�..''z:-
Giimmeii#s (refer to question Explain an YES`answers and/or any recommendations or any; other:commeets. t k,
Use drawttigs of facility to better.egpla�p situations (use aiidtttoni l pages is neces ary)fi ❑Field Copy ❑Final Notes
Reviewer/Inspector Name !
Reviewer/Inspector Signature:
05103101
Date:
Continued

Facility Number: 3 Date of Inspection I Y
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes allo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes [SNo
28. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes 156No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes C&No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes 0 No
-Additional,Comments. an"dlorDraw�ttgs_--
05103101

W x
O Dtyisio`b of Soil astd Water Conservatwn
a - 40
-
Type of Visit - XCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit WRoutine O Complaint O Follow up Q Emergency Not fication O Other ❑ Denied Access
Facility Number
Date of Visit: �s D Time: Z
3
O Not -Operational O Below Threshold
id Permitted [3 Certified Q Conditionally Certified 0 Registered Date Last Operated or Above Threshold: .........•...
FarmName: Qe n SoY► 6''.!"1...................................................................... County: 'rn................................................................
OwnerName:........ ur r..k l...Fn t t LI... ............................................ Phone No:.......................................................................................
Facility Contact:
Title:
MailingAddress: ............................................................................................. ••..................... ..
Onsite Representative: J4 i G � � � �........................................... oy .r
..........................
Certified Operator:
Location' of Farm:
Phone No:
................................................................................... ........ I.................
Integrator: ! o,-01A. f
......`........................................................
Operator Certification lNumber: ,•.•...•••„•••
OSwine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 4 66 Longitude • 6 .At
Design Current
:Switle Capacity Population
-Y ❑ Wean to Feeder
Feeder to Finish
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
_ ❑ Gilts
❑ Boars
'Design Current
Poultry _ Ca acity., Po ulation . Cattle
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity L
Total SSLW _ r
Number of Lagoons 10 Subsurface Drains Present 110 Lagoon Area JE3 Spray Field Area
Holding Ponds / SolidNTraps 10 No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any pan of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes `�No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes eNo
c. If discharge is observed. what is the estimated flow in gallmin? h
d_ Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes §4 No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes Y9 No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ............... I .................. ............. ...................... ................................... ............................................................................................................
Freeboard (inches):
5100 Continued on hack

Facility Number-31— Date of Inspection 1S Printed on:
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 of
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?
1 /9/2001
8. Does any part of the waste management system other than waste structures require Maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding [IPAN ❑ Hydraulic Overload
12, Crop type &rynvd, N0 4. S-MQll 6rq:,L i
13. Do the receiving crops differ with those designated in the Certified
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 & GeneraI Permit readily available?
w 1 r,q
Waste Management Plan (CAWMP)?
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?
� •yiolatigi is:et• dcfciencies wire n�eo djWing phis -visit!. Yoo *"i•teaTito oo flpttitcr
caries otideuce: abo f this visit.
Comments (refer &.4ues# on #):=Explain any YES answers Midtor any_recom>ineadations or`any.-o! coronae i
Use drawings of faciltty:to°hotter ex IaEn,situahans. (use additional pag,40
13, Need .4o oversCed g4 Icasf g6ott4 jO o r 11 ac rey W .be rrq v4
ACCOV- l ^) 4p -FRAJ de-ficil far r,-n �,i S Wa.r IL4 doie,
Q veoaii , jecLG,' 1 14y gno( re o,-dx are we 1 ]ref . Whee,4 Gror S
❑ Yes gNo
❑ Yes 5d No
❑ Yes Jj No
❑ Yes 91 No
❑ Yes R No
❑ Yes MNo
❑ Yes tA No
Yes ❑ No
❑ Yes KNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes J91 No
❑ Yes N No
❑ Yes % No
[]Yes %No
❑ Yes Z No
❑ Yes $j No
❑ Yes No
❑ Yes k No
❑ Yes 0 No
❑ Yes 0 No
❑ Yes KNo
I&
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: ,S' S 0! S/Iryp

Facility Number: 3Date of4nspection IS t7 Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No'
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes LE(No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes XNo
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 A 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 14 No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes O No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
5100

Facility Number 3/ 3 Ualr of Visit•
A Permitted ❑ Certified ❑ Conditionally Certified © Registered
Farm Name Ae » S O h Fa f e-"
3 O0 Time: Printed an: 7/21/2000
0 Not Operational O Below Threshold
Date Last Operated or Above Threshold: .........................
County:
Owner Name: .............. ...Yrr.7......... t j. ...,....... c r►► %.................................. Phone No:
Facility Contact:
.......................................... Title:
Phone No:
MailingAddress:.......................................................................................................................................................................................................... ..........................
Onsite Representative:.. .�.t,h°!e..r..Ajo rrl f 1�fh1 .. kek Integrator:...!. -:./.!fir n xcq!^'-45.............................
. ..........
Certified Operator:
Location 'of Farm:
Operator Certification Number: ..........................................
JE(Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 4 66 Longitude E__10 9 66
DesijpiCurrent
Cad aci .Po uiation
eeder
Finish
ZQ
11 Wean
Feeder
LF
Finish
Ntoaibcr ai Lagoons : ❑ Subsurface Drains Present ❑ Lag -on Area ❑Spray Field Area
$among Ponds /Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge, is observed, what is the estimated flow in gal/tnin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure S
Identifier: ................ f..........................................................................................................................................................
Freeboard (inches): 3I
5100
❑ Yes 0 No
❑ Yes
of No
❑ Yes
CdNo
3? A
❑ Yes
9No
❑ Yes
OrNo
❑ Yes
25No
❑ Yes [RNo
Structure 5
Continued on back

Facility Number: 31 — 311 Date of Inspection Printed on.• 7/21/2000
i
5. Are e there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
Pf No
' seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
Cl Yes
rNo
(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
0 No
8. Does any part of the waste management system other than waste structures require maintenanceRmprovement?
❑ Yes
]A No
9. Do any stuctures Iack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
A No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
A No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
No
12. Crop type e.- dA Y, ifS,ti,� r1 ��� 1"1 Se ea
13. Do the receiving crops differ with tho(a designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
No
14_ a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
P�No
16. Is there a lack of adequate waste application equipment?
❑ Yes
)gNo
Required Records & Dncuments
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
�g No
18_ Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
No
(ie/ WUP, checklists, design, maps, etc")
[—]Yes
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
Of No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
Co No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
�TNo
(ie/ discharge, freeboard problems, over application)
❑
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
❑ Yes
'Fir No
24. Does facility require a follow-up visit by same agency?
❑ Yes
No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
yiolaiions;or deficier�cles "were hoteii• OtWifig #his;visit: • Y;ou will •i•eedW yid further
corresponcCence: at�otit this .vi5it� ...:........:... " ................... .
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):
19. ge Svre 4o �
Vser�rro)Xj
rf Of c� a4 Wck_54 ghrl7siS f-2`"Z
�Jo4e j�ofil-TinG/f U�� r� i Mdf i,, 4-tie i�/a—qB pf tmpp L"Add to fIoh if
114 w;11 �e 1'-"-;346A .
Reviewer/Inspector Name Jj�6 rle L,,ry f %�.q�-� 3S
Reviewer/Inspector Signature: Date: 3 5/00

Facility Number: Date of Inspection d0 Printed on: 7/21/2000
Cdor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge :Wor 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 O No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 0 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 19 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 No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? Yes ❑ No
Additional omments and/orDrawings:
i
5100

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Bill Holman, Secretary
Kerr T. Stevens, Director
Murphy Family Farms
Benson Farm
P.O. Box 759
Rose Hill NC 28458
Dear Murphy Family Farms:
I T Ifflu"FA / • 0
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
December 30, 1999
Subject: Fertilizer Application Recordkeeping
Animal Waste Management System
Facility Number 31-39
Duplin County
This letter is being sent to clarify the recordkeeping requirement for Plant Available Nitrogen (PAN)
application on fields that are part of your Certified Animal Waste Management Plan.
In order to show that the agronomic loading rates for the crops being grown are not being exceeded, you
must keep records of all sources of nitrogen that are being -added to these sites. This would include nitrogen
from all types of animal waste as well as municipal and industrial sludges/residuals, and commercial fertilizers.
Beginning January 1, 2000, all nitrogen sources applied to land receiving animal waste are required to
be kept on the appropriate recordkeeping forms (i.e. IRR1, IRR2, DRYI, DRY2, DRY3, SLURI, SLUR2,
SLD1, and SLD2) and maintained in the facility records for review. The Division of Water Quality (DWQ)
compliance inspectors and Division of Soil and Water operation reviewers will review all recordkeeping during
routine inspections. Facilities not documenting all sources of nitrogen application will be subject to an
appropriate enforcement action.
Please be advised that nothing in this letter should be taken as removing from you the responsibility or
liability for failure to comply with any State Rule, State Statute, Local County Ordinance, or permitting
requirement.
If you have any questions regarding this letter, please do not hesitate to contact Ms. Sonya Avant of the
DWQ staff at [phone] ext. 571.
Sincerel
a�
Kerr T. Stevens, Director
Division of Water Quality
M. Wilmington Regional Office
Duplin County Soil and Water Conservation District
Facility File
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 Telephone [phone] Fax [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/10% post -consumer paper

[j Division of Soil and Vlrater: Conservation Operation IZevtew
`} 13 Division of Soil and; W -
z
ater Conservatioii Comptiance Inspeefion� - � -,
3 'Wiiision of Water Qu`al�ty Corupltance Inspec on
_13Other Agency Operation Review
x
L ` p
•y
P' Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other �
Facility Number Date of Inspection
-- - --- Time of Inspection C1Q 24 hr. (hh:mm)
Permitted 0 Certified [] Conditionally Certified Q Registered 10 Not Operational Date Last Operated: . _-.-
FarmName:......!^s!-................................................................... County:.................t................................._.......:.......
Owner Name: ...................................... Phone No:
Facility Contact: .................................................... ..... .. Title: . Phone No: ...................
MailingAddress: ........................ c.....c..............................................................
Onsite Representative Integrator: ............ �'`...........................
Certified Operator: ................................................... ............................................... ............. Operator Certification Number:..........................................
Location of Farm:
........................................... .............................. ...................................................... ............................ ..............................................................................................................
Latitude • 6 •6 Longitude • 0` 44
Design Current - Design Current - _ Design .Current
Swine Capacity Po elation _Poultry :Ca achy Po `elation Cattle Capacity 'Population
❑ Wean to Feeder ❑ Layer " ❑ Dairy
Weeder to Finish JE1 Non -Layer _' ❑ Non -Dairy
❑ Farrow to Wean
❑ Other :.
❑ Farrow to Feeder
❑ Farrow to Finish Total Design Capacity
❑ Gilts,
❑ Boars r Total IS LW
4Niamber of Lagoons JE3 Subsurface Drains Present agoon Area I0Spray FieldArea
Ho
ldrng Ponds I Solid Traps ❑ No Liquid Waste Management System
: _
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: [:]Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min'?
d. Dues discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes E%No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes CNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes KNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): ..............................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, [] Yes �<No
seepage, etc.)
3/23/99 Continued on back

Facility Number:` — Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan'?
El Yes
-9No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
,kNo
8. Does any part of the waste management system other than waste structures require maintenarice/improvement?
❑ Yes
XNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
jRr No
Waste Application
1.0. Are there any buffers that need maintenance/improvement?
❑ Yes
U No
It. Is there evidence o over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
10 No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
XNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
�RNo
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
C511yes
_ ❑ No
15. Does the receiving crop need improvement?
❑ Yes
ONo
16. Is there a lack of adequate waste application equipment?
❑ Yes
N No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
k No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
gNo
19. Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
D�No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
ONo
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
-j No
22_ Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes M. No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes KNo
24_ Does facility require a follow-up visit by same agency? ❑ Yes E$No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes b;�No
Ri6•vi61ati6 is;oi: deficleacies were itgkea- d&iiig jhis;visJC • You will-r; ecei 4 t?o fp�ther
cories oricience: abauti this :visit.... ...... .... • .. .
e
Comments (refer to questi6 #) Explain any.YES answers.an_T_d/orany recommendations or any other comments =
11§eArawings-of taci ity to'better: explain situations (use additional;pages`as=necessary) m - — —r
v, L'i --- -) y 1� L 5 y (1 � � "t
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
3/23/99

Facility Number: f — 3 Date of Inspection f 1�
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
rKA'es
❑ 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
fij�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
k`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, cte.)
❑ Yes
No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
gNo
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
n No
_ etiona omments an or rawings:
�.
3/23/99

[J Division of Soil and Water Conservation Other Agency
r LL
Division of Water Quality
Routine . O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Facility Number
Date of Inspection JDI
1 3
Time of Inspection 004 24 hr. (hh:mm)
D Registered IF Certified ©Applied for Permit ;%Permitted 113Not Operational I Date Last Operated:
Farm Dame. Rtv'soth ..........
............ County: ....... DVl ..Jjr.................•-.........................................
r
Owner Name: ..................�..........`.... / ....��^SA _►�y..... Q,'hr ......................I....
Facility Contact: 1 llitk.........L!&C' �K 11......... Title:
............ .......... .......
Mailing Address: b 4,_. �Sr1
O.CA Onsite Representative: ............ &IO..._M a ....................... ..............
Certified Operator,.........
Location of Farm:
Phone No:...... ..........
Phone No: ..... (T 9�-0 A::%A.3.•..•.•..
oS4.....i'!1 14A....,.................................. ... �$......
Integrator: ........ 1...
l,.................................................
Operator Certification Number. ........................................
Q.6 .�....,:1..... ....J�3(} I.t...�:.a ..e�csa. AL
...luks.t...e.._..-.1�..1.Q i.'..................................................................................
.................................•--•---- •-- •-- ---•.. ...... .....
Latitude 0 6 " Longitude • ' 44
General
1. Are there any buffers that need main tenancelimprovement? ❑ 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 14 No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes 18 No
c. If discharge is observed, what is the estimated flow in gal/min?
A
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
. q No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
[] Yes
M No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
[A No
maintenance/improvement?
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
'AA
Noz
7/25/97
\

Facility Number: — 3
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons.Holding Ponds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2
Identifier:
Freeboard(ft):..............o.................. I.........................
10. Is seepage observed from any of the structures?
Structure 3 Structure 4
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
No
❑ Yes
No
Structure 5 Structure 6
❑ Yes
13 No
❑ Yes
® No
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 adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
11 `
15. Crop type ............ p! M.�!a............--,T" s..L . Y1i�k',.a......------..------.. . ............r�'1t.------......
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0 No.vio�lationsoi deficiencies wtre noted dtiring this:visit.. Yoil:vKil receive no furtliei
:-:-ct}rrespQndenceabvu�this:visit.-:-:�.:�:-:-:.• �.:.�::�.•:.�. .......... .�
17. k,� ,rc�,,o�L VO[U.kc#-
Yes ❑ No
❑ Yes & No
❑ Yes IgNo
❑ Yes tallo
❑ Yes ® No
M Yes ❑ No
❑ Yes g] No
❑ Yes I& No
❑ Yes 91 No
❑ Yes NfNo
❑ Yes R No
❑ Yes, W)No
❑ Yes UNo
7125/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: -%t,1` Date:

O Routine 0 Complaint O Follow-uE of DW2 inspection O Follow-up of DSWC review O Other
Facility Number Date of Inspection
Time of Inspection J�' 24 hr. (hh:mm)
Total Time (in fraction of hours �
Farm Status• Registered ❑ Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review9
Certified ❑ Permitted or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated:
Farm Name:county: .......[qixk................... .... _.....
J
Land Owner Name:.....�uri1... �i�.......xYlS......_...................... Phone No: .._....... ........ _....... __..........
Facility Conctaet:.J'`,...._LSriRfli..._._. Title: ..._ Phone No:
Mailing Address: .C1e ............... __..... ...._............ ..... ....... .
Onsite Representative:.... (r „...._........Integrator:._�� l
�
Certified Operator: r
p ..#�tY.I.S.....L,e�.t.,`5..............._......._.............._............_._.... Operator Certification Number: _....t�77f............_..,
Location of Farm:
Latitude a 6 Longitude • 4 �K
Type of Operation and Design Capacity
Design Cirrent��� Designer Current r� Des�gri Current
Swrae Ga aci :.;.Po itlationPoultry.t Ca aciPo"ulation»- Cattle:. Ca aci 1Po ulattoia
❑ Wean to Feeder ❑ 1, 10 Da'
Feeder to Finish O IQ Non- ZMjEl Non -Da'
1.13 Farrow to Wean
Farrow to Feeder TotalDesign Capac�t>Ey z0 t Y
Farrow to Finish, f
Number of 1C.agoops'J Holding Ponds [� Subsurface Drains Present
❑ Lagoon Area Spray Field Area
jjeneral
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (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)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
❑ Yes ® No
❑ Yes ,® No
❑ Yes JO No
❑ Yes ® No
❑ Yes
® No
❑ Yes
(4 No
❑ Yes
No
❑ Yes
No
Continued on back

Facility Number:... �}.._—....�`�.•.-
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 5a No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes ® No
S. Are there lagoons or storage ponds on site which need to be properly closed? Yes ❑ No
Structures_(j,a;oons and/or Folding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate? Yes ❑ No
Freeboard (R): Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
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 adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or ppru�'n��off entering waters of the State, notify DWQ)
15. Crop type , .... s ! -. � �txul�b...... ......... ...- .... ........ ..... jc-, l e/.... _....... ...................
16. Do the receiving crops differ with those designated in the Animal Waste Management PIan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
2I. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
ForCertified_Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
❑ Yes J@ No
❑ Yes Q No
® Yes ❑ No
❑ Yes [A No
EM Yes ❑ No
❑ Yes t-No
❑ Yes R No
❑ Yes
11� No
❑ Yes
�kNo
l}Yes
❑ No
❑ Yes [& No
❑ Yes j& No
❑ Yes 1P No
❑ Yes ® No
Comments .{refer to}queshbn`#)Ezplam any YES `answers and/or any recommendat�ans or ariy other comments:
Use drawings; of facility to better explain situations. {use additional pages as necessary)' ti '�
sk►,5 IiLy6n 'sys{-c� a3111 be "c,krsc� oU'i' l s4cr -e will 6e fe6 fcj 4
to C'V% P—)q tied )p�e - Clost odC platvS a*e, Ate" 4, SltUjge k#j-ccfah.
9. z-'J'r SAage [a�{,� InaS �Ka�e�Ua�t „cfWor�l�. � f $h��� b� pum�e� "owh oh Armwidr C"ims
OA (,�Lk�r. s6J13 �,, h41kJ VA�;1 `4066
Iover
Iay`�c�KGisr'�``miiuLY6, at AUCO-
7-- ra4 rS tt, p xess o� ov��n)JiaooLt iyr -6 c,► exparded
Sinj6_ 10.GC�*U
. &oAa�
walk will n� soa-1Z Ih #� ct�S a� �Ica�id�
tir1C�t,, �e fti.+na�- Naas 4j�se-Wt:�•
Reviewer/Inspector Name h;
Reviewer/Inspector Signature: Date:
cc. Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

Site Requires Immediate Attend :
' Facility No. 3
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
7 �.
DATE: , 1995
Time:
5 any
Farm Name/Owner: M(&
Mailing Address:
County:
I/N . _-� n7_ I . � — n
Integrator: ph
On Site Representative:
Physical Address/Location:
Type of Operation: . Swine ✓ Poultry Cattle �i � k, 5�
Design Capacity: Number of Animals on Site: t*o a
DEM Certification Number: ACE DELI Certification Number: ACNEW
Latitude: 35— °y 3 ' ttLongitude: 7_" 5_9 , 36 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)(D or No Actual Freeboard: _2--Ft. Inches
. Was any seepage observed from the lagoon(s)? Yes ore7as any erosion observed? 0e or No
Is adequate land available for spry? or No Is theme over crop adequate? Gor No
.4 0
Crop(s) being utilized: QA74-�E `4 S Vvif�=V��D ft4LL"C' I -
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings or No
100 Feet from Wells? 6or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes oKo
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line?' Yes o d
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or& If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? 5 or No
Additional Comments: _ ' X I a
�• i���jj•
Inspector Name
Signature
cc: Facility Assessment Unit
Use Attachments if Needed.