820700_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qua

Type of Visit: (-Compliance Inspection O Operation Review O Structure Evaluation U Technical Assistance
Reason for Visit: gDrkoutine Q Complaint O Follow-up O Referral Q Emergency Q Other d Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region: ��
Farm Name: � Sd U � Tti! L Owner Email:
Owner Name: It'�1,y Phone:
Mailing Address:
Physical Address:
Facility Contact: r(^-( Title: Phone:
Onsite Representative: Integrator:
Certified Operator: �C Certification Number. 9 �`
Back-up Operator: Certification Number:
Location of Farm:
a
Latitude:
Longitude:
Design Current
Swiqe Capacity Pop.
a Current 4 'Design Current
Wet Pot►1 -Capacity Pvp. Cattle ,' `Capacity Pap -
Wean to Finish
La er
Non -Laver
Dairy Cow
Wean to Feeder
O-W
Dairy Calf
Feeder to Finish
Y
-:Desi n
aci
Fa ers
Non -La ers
Pullets
Current
P,vp.
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dry Cow
Hon -Dairy
Beef Stocker
Gilts
Beef Feeder
Boars
Beef Brood Cow
Other
Qther
Turkeys
_
Turkey Pouets
Other
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 4 o ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No �A ❑ NE
b. Did the discharge reach waters of the State? (if yes. notify DWR)
❑ Yes ❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d_ Does the discharge bypass the waste management system? (if yes, notify DWR)
❑ Yes ❑ No
El NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes ,ETrNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes [r, No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

FaraG Number: - p jDate of Inspection. Zd D
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [] No [A-t+A ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 53
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 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 ❑ 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 C No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes r to ❑ 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 2-V�es E30:�o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E]r'-No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes
�o
❑ 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 e f r.4 X r,
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Q-Nb
0 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 ❑ Ycs
Na
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E3 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E3<o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes l_2'110 ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes L. Ko ❑ 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 E7No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
[:]Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes � ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

F 'I' Number: - Date of Inspection:3 d JV4015
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[5` oo . ❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
©'No ❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey El 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
[b! No ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
LJ,X'6 ❑ 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 []' i�o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes 21Z ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [:]Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
Q'llo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
[3 t o
❑ NA
❑ NE
gs,;o f cili tp liet#er,ex [amastfuah n 'ruse ad td tonMA
" sI a eras necessa :.
aj� Ito -jog-- tgsi
Reviewer/Inspector Name: �1�—E)VA44 _ Phone: 3-331
All L V
Reviewer/Inspector Signature; Date: b
Page 3 of 3 21412015

43 (A-5
(Type of Visit: Q<omp ' ce Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time_ DepartureTime: Ii D County:
Farm Name: 1 55 D y" Owner Email:
Owner Name: — � d Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: Phone:
Region:
Mg —
Onsite Representative: 1 Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation? [:]Yes No ❑ NA ❑ NE
i
Discharge originated at: ❑ Structure [] Application Field ❑ Other:
a. Was the conveyance man-made? Yes No dNA NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) Ej 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 Na EffNA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes �No El NA El NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters El Yes [frNo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

L
Facility Number: jDate of Inspection:
Waste Collection & Treatment J ��,,��
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 1.go [] NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No []7�A ❑ 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 Q?c ❑ 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 L`J 1"0 ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? [] Yes [?(No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes Egf4o ❑ 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 Annllcatlon
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [p]"?<ro' 0 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): .e—J'
13. Soil Type(s): Wo 6 o
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes a`�o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [ "] cs [] No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [TNo ❑ 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?
❑ Yes dNo ❑ NA ❑ NE
❑Yes �No ❑NA ❑NE
Re aired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes E3No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [( No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists 0 Design ❑Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [� No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes dNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [2"No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

�- IL
Facility Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
is ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check
E2fes
[-]No ❑ NA [] NE
the appropriate box(es) below.
❑ Fai re to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
on -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
Er No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[frNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
VNo ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concerts?
❑ Yes
[�No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[::fNo ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
dNo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the pen -nit or CAWMP?
❑ Yes
No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No ❑ NA ❑ NE
Reviewer/Inspector Name: g m Phone: q r
Reviewer/]nspector Signature: 0 Date: J
Page 3 of 3 2/4lZ014

30
t ype u1 visit; v %_ompitance inspection v 13peranon mevtew lJ Structure rJvatuatton v i ecnnicai Aassistance I
Reason for Visit: (D Routine Q Complaint 0 Follow-up O Referral O Emergency Q Other Q Denied Access
Date of Visit: a4 5 Arrival Time: /D 3o Departure Time: f e / a County:
Farm Name: 1 { Sj a &-^ Owner Email:
Owner Name: tnu!!Lt _ r Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: j
Certified Operator: L
Back-up Operator
Location of Farm:
Phone:
Integrator: iM 3
Region:F2
Certification Number: 7 t S 73 4
Certification Number:
Latitude: Longitude:
Current
Design Current Design Current Design.00
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle _ Capacity Pap.
Wean to Finish Layer Da' Cow
Wean to Feeder
Non -ha er
DairyCalf
Da' Heifer
Feeder to Finish
a
Design Current
1) , Poult . Ca act P,o
Farrow to Wean
D Cow
Farrow to Feeder
Non -Dairy
Beef Stocker
Farrow to Finish
Layers
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
... , .
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes Lg- ❑ NA ❑ NE
❑ Yes
[] No
C3 NA
❑ NE
❑ Yes
[-]No
E; "<
❑ NE
❑ Yes ❑ No
[-]Yes %To
❑ Yes EfNo
+TA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page I of 3 21412014 Continued

Faeflity Number: FE7g- Ds ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [-]Yes r [DNA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [P 1 X ❑ 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 Q lq-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 ETNo ❑ 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 [ '1 o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [3No ❑ 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 [T No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes EJ-N-o ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [jj>o ❑ 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): l) v__ wy't� , j w 11 _
13. Soil Type(s): 11_e4 �,• C ��►,•'llf�_�✓-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Ohio ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [-]Yes [gWo ❑ NA ❑ NE
acres determination?
IT Does the facility lack adequate acreage for land application?
❑ Yes
[3No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ 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
[2r<o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[—]Yes
G3 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[—]Yes
ENo
❑ NA
❑ NE
Page 2 of 3
21412014 Continued

Facili Number: - Date of Inspection: sic.
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes D-No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes [;No [DNA ❑ NE
the appropriate box(es) below.
n 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 �o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[B"No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
Oa o
Q NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
Eff <0
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
Ej'_N o
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other_
32. Were any additonal problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Cl"No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an an -site representative?
❑Yes
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
YNo
D NA
❑ NE
Comments (refer to question #): Explain any;YES answers and/or any additional ecommendations or any other comments.
Use drawings of facility to better explatn.situations (use additional pages as nec'essary).=,
72-(A t1S 0C+lot,
9(4 sup , do —IS —Iq
Reviewer/inspector Name-
Reviewer/inspector Signature:
Page 3 of 3
Phone: q33 63 3
Date: k'-sa-i tS
21412014

Type of Visit: e Compliance Inspection 0 Operation Review C) Structure Evaluation 0 Technical Assist
Reason for Visit: 4 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 1 0 Denied Access
Date of Visit:
Q / Arrival Timer
Departure Time:
`-- p County:
Region:
Farm Name:
p
Owner Email:
Owner Name: _PM jjW2, f- r> 65-e &C.LCPhone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: Integrator: &2Z Q4-1,Jt)
I lee
Certified Operator:7� �}�� Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Design
Current Design .Current
RetPoultry
Design Current
Saline Capacity
Pop. Capacitf Pop.
Cattle Capacity Pop.
can to Finish
Layer
Dairy Cow
Wean to Feeder
Non -La er
DairyCalf
DairyHeifer
eeder to Finish
"' "
Farrow to Wean
ow
Design Current
Cow
Farrow to Feeder
I) . Poultr Ca aci
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Beef Feeder
Beef Brood Cow
Non -Layers
Pullets
Boars
Turkeys
Other
Turke Poults
Other
Other
Discharges and Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d_ Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than froth a discharge?
Page I of 3
❑ Yes o ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:)Yes ❑ No [DNA ❑ NE
❑Yes ❑N ❑NA ❑NE
[—]Yes ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
2/4/1011 Continued

acility Number: 0 - Q Date of Inspection:
Waste Collection & Treatment
4_ is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ 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: �l
Spillway?:
Designed Freeboard (in): Jam.
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 ❑ 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
/th at, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[]'No ❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
ffNo ❑ NA
0 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
'ram - ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
fo ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
L-d'1 o ❑ 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
o . ❑ NA
❑ NE
15, Does the receiving crop and/or land application site need improvement?
❑ Yes
5io _ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
o [DNA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑Yes
IDI4o�`Q NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑Yes
OX01 ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑'hlO ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available'? If yes, check
❑ Yes
NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
o ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
❑ No ❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[—]Yes
6/No ❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facili Number: - minspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
Yes
' o NA NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
Yes
[ No D NA [D 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
NA -� NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Yes
VN;o D NA D NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes
NA NE
and report mortality rates that were higher than normal?
ZN�o
29. At the time of the inspection did the facility pose an odor or air quality concern?
Yes
[] NA NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[] Yes
No [] NA NE
permit? (i.e., discharge, freeboard problems, over -application)
ZNo
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
Yes
NA NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
Z'X0
32. Were any additional problems noted which cause non-compliance of the permit or CA WMP?
0 Yes
D NA NE
33. Did the Reviewer/Inspector fail to discuss reviewtinspection with an on -site representative?
Yes
M [] NA NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No ❑ NA [] NE
Comments (refer to question ft �Eiplain any YES answers and/or any additional recommendations or any other comment `
[Use drawings of facility to better explain situations (use additional pages as necessary).
amp1d t4vt*w_J
3. !�
0. v --
2tj &uc15 4/r7 e
15
201
Reviewerlinspector Name:
Reviewer/inspector Signature:
Page 3 of 3
O-SiO­ Ay't-' 4's► 'S
IV
4k/4)13
I. ?G
0//VI) 3
�•54
3f18�r3
a-�'
2z//3
7
dri
96 vn �4_
Phone: 31
Date: 0 // /
21112011

Division of Water Quality
❑ Division of Soil and Water Conservation
❑ Other Agency
Facility Number; 820700_ _ _ Facility Status: Active Permit: AWS820700 ❑ denied Access
Inspection Type: Compliance Inspection Inactive or Closed Date:
Reason for Visit: Routine County: Sampson _ Region: Fayetteville
Date of Visit: 10/11/2013 Entry Time: 11A8 AM _ Exit Time: 12:20 PM Incident #:
Farm Name: Blossom_1nc Owner Email:
Owner: Dm Farms Of Rose Hill LLC Phone: [phone]
Mailing Address: PO Box_1_139 _ _ Wallace NC 284661 1_3S
Physical Address: 12a� NjIbuLl'.Hdven Rd Hijolls NC 28444
Facility Status: 0 Compliant ❑ Not Compliant Integrator: Murphy -Brown LLC
Location of Farm: Latitude: 1'4 " Longitude: 78'18'35"
from Harrells, take NC 41 South toward Whitelake, go about 7 miles and turn lets onto SR 1120. Go 1.5 miles then turn right onto
SR1121 and go 0.2 miles to farm entrance an right.
Question Areas:
Dischrge & Stream Impacts Waste Col, Stor, & Treat jj Waste Application
Records and Documents Other Issues
Certified Operator: Douglas Stephan Atkins Operator Certification Number: 985738
Secondary OIC(s):
On -Site Representative(s): Name Title Phone
24 hour contact name Doug Atkins Phone:
On -site representative Doug Atkins Phone:
Primary Inspector: Ronnie T Smith
Inspector Signature:
Secondary Inspector(s):
Phone:
Date:
Page: 1

Permit: AWS820700 Owner - Facility: ©m Farms Of Rose Hill LLC Facility Number: 820700
Inspection Date: 10/11/2013 Inspection Type: Compliance Inspection Reason for Visit: Routine
Inspection Summary:
CoC in records
WUP 7199
Crop yield reviewed
Sludge Survey 10/3/13
**due again 2014**
thickness = 3.3
LTZ = 3.4
pump intake = 4.2
44%
Soil Test 11/27/12
L = 0.0T
Cu & Zn levels w/in range
**due again 2015**
irrigation calibration 2011
**due again 2013**
irrigation records to rainfall and lagoon records
Waste Analysis N
8/16113 = 1.36
6/14/13 = 1.87
5/24/13 = 3.26
4/25/13 = 2.57
3/18/13 = 2.53
2/15/13 = 2.65
1/22/13 = 1.57
**" Please focus on revegetating back and right side of lagoon banks***
Page: 2

Permit: AWS820700 Owner - Facility: DM Farms Of Rose Hill LLC Facility Number: 820700
Inspection Date: 1011 U2013 Inspection Type: Compliance Inspection Reason for Visit: Routine
.Regulated Operations Design Capacity Current Population
Swine
Q Swine - Wean to Feeder 7,800 7,800
Total Design Capacity: 7,800
Total SSLW: 234,000
Waste Structures
Designed Observed
Type Identifier Closed Date Start Date Freeboard Freeboard
agoon 1 27.00 54.0(
Page: 3

Permit: AWSB20700 Owner . Facility: Dm Farms Of Rose Hill LLC Facility Number : 820700
Inspectlon Date: 1011112013 Inspection Type. Compliance Inspection Reason for Visit: Routine
Discharges & Stream Impacts Yes No NA NE
1. Is any discharge Observed from any past of the operation? ❑ ■ ❑ O
Discharge originated at
Structure ❑
Application Field ❑
Other ❑
a. Was conveyance man-made? ❑ M ❑ ❑
b. Did discharge reach Waters of the State? (if yes, notify DWQ) ❑ ■ ❑ ❑
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ) ❑ ■ ❑ ❑
2. Is there evidence of a past discharge from any part of the operation? ❑ ■ ❑ ❑
3. Were there any observable adverse impacts or potential adverse impacts to Waters of the State other than ❑ ■ ❑ ❑
from a discharge?
Waste Collection, Storage S Treatment Yes No NA NE
4. Is storage capacity less than adequate? ❑ ■ ❑ ❑
If yes, is waste level into structural freeboard? ❑
5. Are there any immediate threats to the integrity of any of the structures observed (I.e.1 large trees, severe ❑ ■ ❑ ❑
erosion, seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a waste management ❑ ■ ❑ ❑
or closure plan?
7. Do any of the structures need maintenance or improvement? ❑ ■ ❑ ❑
B. Do any of the structures lack adequate markers as required by the permil? (Not applicable to roofed pits, ❑ ■ ❑ ❑
dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require maintenance or ❑ ■ ❑ ❑
improvement?
Waste Application Yes No NA NE
10, Are there any required buffers, setbacks, or compliance alternatives that need maintenance or ❑ ■ ❑ ❑
improvement?
11. is there evidence of incorrect application? ❑ ■ 0 ❑
If yes, check the appropriate box below.
Excessive Ponding? ❑
Hydraulic Overload? ❑
Frozen Ground? ❑
Heavy metals (Cu, Zn, etc)? ❑
Page: 4

Permit: AWS820700 owner - Facility. Dm Farms Of Rose Hill LLC
Facility Number: 820700
Inspection Date: 10/11/2013 Inspection Type: Compliance Inspection
Reason for Vislt: Routine
Waste Application
Yes No NA NE
PAN?
❑
Is PAN > 10%/10 lbs.?
❑
Total Phosphorus?
❑
Failure to incorporate manurelsludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
Crop Type i
Summer Annual
Crop Type 2
Winter Annual
Crop Type 3
Coastal Bermuda Grass
wl Rye Overseed
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Leon sand, 0 to 2%
slopes
Soil Type 2
Cainhoy sand, 0 to 5%
slopes
Soil Type 3
Soil Type 4
Soil Type 5
Soil Type 6
14, Do the receiving crops differ from those designated in the Certified Animal Waste Management ❑ ■ ❑ ❑
Plan(CAWMP)?
15_ Does the receiving crop and/or land application site need improvement? ❑ ■ ❑ ❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? ❑ ■ ❑ ❑
17. Does the facility lack adequate acreage for land application? ❑ N ❑ ❑
18. Is there a lack of properly operating waste application equipment? ❑ E ❑ ❑
Records and Documents Yes No NA NE
19. Did the facility fail to have Certificate of Coverage and Permit readily available? ❑ ■ ❑ ❑
20. Does the facility fail to have all components of the CAWMP readily available? ❑ 0 ❑ ❑
If yes, check the appropriate box below.
Page: 5

Permit: AWS820700 Owner - Facility: Dm Farms Of Rose Hill LLC Facility Number: 820700
Inspection Date: 10/11/2013 Inspection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents Yes No NA NE
WUP? ❑
Checklists? ❑
Design? ❑
Maps? ❑
Lease Agreements? ❑
Other? ❑
If Other, please specify
21. Does record keeping need improvement?
If yes, check the appropriate box below.
❑■❑❑
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
0
Weather code?
❑
Rainfall?
❑
Stocking?
❑
Crop yields?
❑
120 Minute inspections?
❑
Monthly and 1" Rainfall Inspections
O
Sludge Survey
11
22. Did the facility fail to install and maintain a rain gauge?
❑ ■ Q ❑
23. If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment (NPDES only)?
❑ ■ ❑ ❑
24_ Did the facility fail to calibrate waste application equipment as required by the permit?
❑ ■ ❑ ❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check the appropriate
❑ ■ Q ❑
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:
Page: 6

Permit: AWS820700 Owner - Facility: Dm Farms Of Rose Hill LLC Facility Number: 820700
Inspection Date: 10/11/2013 Inspection Type: Compliance Inspection Reason for visit: Routine
Records and Documents Yes No NA NE
26. Did the facility fail to provide documentation of an actively cetlified operator in charge? ❑ ■ ❑ ❑
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification? ❑ ■ ❑ ❑
Other ISSUES Yes No NA NE
28. Did the facility fail to properly dispose of dead animals within 24 hours and/or document and report ❑ ■ ❑ ❑
mortality rates that exceed normal rates?
29, At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ ■ ❑ ❑
Air Quality representative immediately.
30. Did the facility fail to notify regional DWQ of emergency situations as required by Permit? (i.e., discharge, ❑ ■ ❑ ❑
freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? ❑ ■ ❑ ❑
If yes, check the appropriate box below.
Application Field
Lagoon / Storage Pond
Other
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with on -site representative?
34_ Does the facility require a follow-up visit by same agency?
13
Page: 7

iype of visa: compnance inspection U operation review U Structure Evaluation U Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: /! p Departure Time: /2, County:��t0�Region:
Farm. Name: b1 os'sOr'hi Owner Email:
Owner Name: DM PIWYhS V- 1 05e di 4 4-LC Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator: N
Phone:
Integrator:f,(j,itil%�%
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Destgn C rru ent
Curren#'' Design Curret
WID4Dgn
ly PopCattle Capacity Pap.
' -
Wean to Finish
Layer
Da' Cow
Wean to Feeder
Feeder to Finish
*1
Non -Layer
Da' Calf
t ., t DairyHeifer
Farrow to Wean
Farrow to Feeder
ry PaW
Dt
Desigti" Cuirent• Cow
Ca act Po airy
-Y,
Farrow to Finish
l a ers
q` Beef Stocker
Gilts
�-
Non -Layers
Beef Feeder
Boars
..
"
Pullets"
Beef Brood Cow
:.
Turkeys
Other
Turkey i'oults
Ia.
Other
Other
A
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[ ] Yes P No ❑ NA ❑ NE
[:]Yes [:]No
[-]Yes [:]No
[:]Yes ❑ No
❑ Yes [ No
[:]Yes No
[5aNA []NE
[5jNA ❑ NE
�NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 2142011 Continued

Facili Number:K2- Date of Ins ection: t
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 10 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No &M NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: T- —
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 �q No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [:]Yes [)g No ❑ NA ❑ NE
S. Do any of the structures lack adequate markers as required by the permit? ❑ Yes T 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 J�j No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes ® No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes [V 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 ofAcceptable 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
[P No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
® No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Reayuiired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[] No
❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
[]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
E� No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [] Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
M No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
R No
❑ NA ❑ NE
Page 2 of 3
21412011 Continued
F

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [P No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes EpNo
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 ST No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes M No [DNA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes [�?No ❑ NA ❑ NE
❑ Yes 'E4 No
❑ Yes ER No
❑ Yes E� No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to -question ft Explain any YES answers.and/or.any additional recommendations or any other comments: _
Use drawings 6ffaciliity: to better explain situations (use.additional pages as -necessary). -
Reviewer/Inspector Name:
Reviewer/Inspector Signature;
Page 3 of 3
Phone: 91d :3.�
Date: j 11131 1'L
21412011

Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 4WRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: a (A Arrival Time: �Q Departure Time: ounty: i Region: l'�
Farm Name: 06s;C r ) Owner Email:
Owner Name: DM m S O .pose-d1w�- / Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
�l Title:
k
Phone:
Integrator: Certification Number: Ss73s
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine GapactyP�op.
Design Current Design Current
Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish
La er
Da' Cow
Wean to Feeder
Non -La er
Da' Calf
Feeder to Finish
Design Current
D , P.oultry Ca acity Po ,
DairyHeifer_
Farrow to Wean
Farrow to Feeder
D Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
El Boars
D.ther
Non -Layers
Beef Feeder
Pullets
Beef Brood Cow
Turke s
Turkey Poults
01 Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made'?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes. notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes P No ❑ NA ❑ NE
[] Yes
[:]No
EPNA
❑ NE
[—]Yes
[:]No
T NA
❑ NE
[—]Yes [] No
[:]Yes No
❑ Yes No
NA ❑ NE
NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

vacili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes No NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Struc re 6
Identifier.
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed'? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan'?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [3� No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes (9 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 Lo No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ E�dence of Wind Drift ❑ Application Outside of Approved Arga It
12. Crop Type(s): lam( 3l (9' W%&W4Y1PA Wa1"
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 ❑ Yes l No ❑ NA ❑ NE
acres determination? T
IT Does the facility lack adequate acreage for land application? ❑ Yes 09 No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
TT��
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available'?
❑ Yes
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
US 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
171 No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l " Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[] Yes
M No
❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[P No
T ��
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facilit , Number: - Date of Inspection: 14.101 t,
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Ea No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the ReviewerAnspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
Ep No
❑ NA
❑ NE
❑ Yes
CPNo
❑ NA
❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes T No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
[� No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
(Comments (refer to question #) Explain any YES answers and/or°any additional ff6iittmendations or.;any other conirnents.
Usei drawinks':of facility to better-exj)Mn situations fuse additional_vat?es as necessary,) *.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 9161 -'
Date:
21412011

' IL
type of visit C9'Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Qlfoutine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: ' J Departure Time: County: Region:
Farm Name: ,i S /ern 2.4. Owner Email:
Owner Name: !9'1 r=emw e _12F I L C_ Phone:
Mailing Address:
Physical Address:
Facility Contact: L : a t_Q en: _ Title: Jel iV Phone No:
Onsite Representative: �I/�l,d v 74,t k6 Integrator:
Certified Operator: '-r. Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = { = u Longitude: = o =,
Swine
Design Current
Capacity Population Wet Po111W&C-ZacitY
Design Current
AP,opulation
Desigrt Current
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑Dai Cow
Wean to Feeder
1 2= D
1,79rDV
I ILI Non -Layer
El Dairy Calf
ElFeeder to Finish
ElFarrow to Wean
Dry Poultry
El La ers
❑ Non -Layers
El Pullets
❑ Turke s
Poults
El Dairy Heifer
El Dry Cow
ElNon-Da
[IFarrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
ElBeef Stocker
El Beef Feeder
❑ Beef Brood Cowl
OtherMajurkey
Number of Structures: a
❑ Other
JILUOther
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
[]Yes [RNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
Z.No
❑ NA
❑ NE
❑ Yes
SNo
❑ NA
❑ NE
Page 1 of 3
12128104 Continued

1®
Facility Number: — Date of Inspection -Iti
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[3No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): O` 7 T
Observed Freeboard (in): s::L
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
0 No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
[3No
❑ 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
NNo
❑ 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
9No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[XNo
❑ NA
❑ NE
maintena ncelimprovement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. [:]Yes O No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)�
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ® No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes La No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
I & Is there a lack of properly operating waste application equipment?
❑ Yes
N No
❑ NA
❑ NE
❑ Yes
5INo
❑ NA
❑ NE
Reviewer/Inspector Name may, `�`� Phone: 97�-1-1_?7`r3 0-D
Reviewer/Inspector Signature: Date:
Page 2 of 3
1G/LV/VY l.V{{L{I{{fGV

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [NO ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes allo ❑ NA ❑ NE
the appropriate box.
❑ WL1P ❑Checklists El Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes U3�N0 ❑ 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
allo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�4 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
[4 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
V[No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
MNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CA WMP?
❑ 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
[RNo
❑ 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
J.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
allo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
QNo
❑ NA
❑ NE
Page 3 of 3 12128104

FI MS x V 15-10 q
Type of Visit Q Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: l j �� L Arrival Time: Departure Time: ri County: Sam
Farm Name: Z10Owner Email:
Owner Name: NJ Famir a(— RUSQ_ W1 Ll r- Phanec
Mailing Address:
Physical Address:
Region: 47_
Facility Contact: r Title: Phone No:
J r)
Onsite Representative: Integrator: U1 — Ryon t V h4y) f
Certified Operator: 1't L)3Ir _ _ Operator Certification Number: 9R."
Back-up Operator: Back-up Certification Number:
o Location of Farm: Latitude: = 6 = it Longitude: =
o
Swine
Design Current
' Ca pacityPoptilation
Design Current
Wet Poultry Capty Population
Design Eurrent
Cattle Capacity Population
❑ Wean to Finish
airy Cow
airy Calf
Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
I
:
MEN]Poultry
❑ La ers
❑ Non -La ers
❑ Pullets
ues
❑ Turkeys
❑ Turkey Pouets
NFEI Other
❑ Dairy heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑Beef Feeder
❑ Beef Brood Co
triumbe€ of Structures:
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes 12 No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
Z. Is there evidence of a past discharge from any part of the operation? ❑ Yes lR] No ❑ NA ❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑ Yes El No ❑ NA ❑ NE
other than from a discharge?
12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �RNo ❑ 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): QL_7
Observed Freeboard (in): 65-
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
® No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
[2 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
10 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
S 'No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
CRNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)Cmla I
komJ&
ffiv sco
13. Soil type(s) Cab S ' - A S '
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
allo
❑ 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
E" No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[RNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Comments (refer to guesd6o _#) ;Explain any - WE Savers and/or any recorn endat>ions or any other comment_s..
Use drawings of facility to hitter explain situations (use additional pages`as necessary)`.
,tea
•
Reviewer/Inspector Name '(� G� 3
�R.�1� � ctt � �:c � Phone- . {q r0 �33
Reviewer/Inspector Signature: 5 � Date: j '3OL►
J 12128104 Continued

Facility Number: dg — Date of Inspection I�+Z
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes t}No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [S No El NA El NE
the appropriate box. ❑ WUp [I Checklists [I Design'
❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes � No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
Q No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
N 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
q 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
UNA
❑ 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
NNo
❑ 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
RNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
soI1 on11, j
12128/04

Facility No, S2000 FaName
Permit ''� COC
Date
OIC, 1 NPDES (Rainbreaker PLAT Annual Cert )
Hi APIL MAGI U11✓ :ar t_ &:f2 .5EP7 J�
SR147�nF7�
Lagoon
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard(in))`
Sludge Survey Date o!?.Iwq
Sludge Depth ft& %
Liquid Trt. Zone ft
Calibration Date
1
2
3
4
5
6
7
8
Design Flow
Actual Flow
Design Width
Actual Width
Soil Test Date Wettable Acres Weather Codes
pH Fields WUP Transfer Sheets
Lime Needed Weekly Freeboard R- GAUGE
Lime Applied Rainfall >1" ✓ ead bo or incinerator
Cu Zn 1 in Inspections Morta i y ecords
Needs P 120 min Inspections SPfoy v
. MO
N'T"MI(TTEM Man
ffi�W I
PuIIIField
Soil
Crop
RYE
PAN
Window
Max Rate
Max Amt
}06
ha,
a
-sP
He
LfA
!
-XA
i
Verify PHONE NUMBERS and affiliations
Date last WUP FRO Date last WUP at farmQC(
FRO o(F rm ecords
Lagoon
Top Dike 104-jb
Stop Pump QQ-10
Start Pump lf) Q 0
Approx. Conversion- Cu-I 3000= 108 Iblac; Zn- 3000 213 Iblac
App. Hardware
Sol �`V
`tookajp, *� c-W 3laoo?�
�T

• Division of NYater Quality
Facility Number q w 0 division of Soil and Water Gonservation
Other Agency , _.— 0
Type of Visit • Compliance Inspection Q Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit ® Routine Q Complaint 0 Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: `T' -' S Region:
Farm Name: _ Blossom t r _ _ _ Owner Email:
Owner Name: _ k glo! ern Phone:
Mailing Address:
Physical Address:
Facility Contact: _ D�O$SOXI'j Title:
d
Onsite Representative:
Certified Operator:
Back-up Operator -
1+
j
�(,, Phone No:
Integrator- / "1 11J4
Operator Certification Number:
Back -up Certification Number:
Location of Farm: Latitude: = = = Longitudes = Q = 1 = u
Swine
Design
Capacity
Current Design Current
Population Wet Poultry Capacity Population
❑ La er
❑ Non -La erEEJ
"
Dry Poultry = ``
Layers
Desilowgn Current
Cattle Capacity Population
❑ DairyCow
❑ Dairy Calf
El Dairy Heifer
❑ D Cow
❑Non -Dairy
❑Beef Stocker
❑Beef Feeder
❑ on -Layers
Qther
❑ Pullets
❑ Turkeys
[]Turkey Poults
❑ Beef Brood Co
Number of Structures:
❑ Other ❑ Other
❑ Wean to Finish
eanto Feeder �
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑Yes
RNo
❑ NA
❑ NE
Discharge originated at: El Structure ❑Application Field El Other
a. Was the conveyance man-made?
❑Yes
❑ No
PKNA
❑ NE
is. Did the discharge reach waters of the State? (!f yes, notify DWQ)
❑Yes
[]No
AQNA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
El Yes
❑ No
%�jVA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑Yes
❑ No
t&NA
❑ NI:
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑yes
❑ No
9;LNA
❑ NE
other than from a discharge?
Page I of 3
I2/28/04
Continued

{
Facility Number: Date of Inspection
Waste Collection & Treatment
❑
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
L] No ❑ NA NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No BNA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): y
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ENo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
25No ❑ 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
9No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
9No ❑ 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
RNo ❑ 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
F.NO ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 101bs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside off� Acceptable
pt��able Crop Window ❑ Evidence of Wind Drift El Application Outside of Area
cej�
12. Crop type(s) O
u[ &' 4, , 5 (ok � 5i.. Q
�
13.
Soil type(s) QtN'h
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
fZNo
El 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
N No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
EANo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Reviewer/Inspector Name I . Phone,`9!Q
Reviewer/Inspector Signature: Date:
rage _Z of J [LiL oivY a.uru„euo.

1
• Facility Number: —7oQ Date of Inspection
Re wired 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 D,No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes F.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
U�No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
ZIYes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
29 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
ISNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
W 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
V 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
Wo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewedlnspector fail to discuss review/inspection with an on -site representative?
❑ Yes
1)�No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
3 No
❑ NA
❑ NE
Additional Comments and/or Drawings:
OL04�p/ C474,, Atu�5-
Al �� 6L4- )
S
Page 3 of 3 12128104

J
Division of Water Quality
Facility Number' Da O Division of Soil and Water Conservation
O Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:*6�0��;Soj
Arrival Time: �• Q Departure Time: ie-21 County. `�f ' Region:)Farm Name: '►'1 L 'tCr Owner Email:
Owner Name: "L13 0 -SD /14 Phone:
Mailing Address:
Physical Address:
Facility Contact:Title:
N
Onsite Representative:
Certified Operator:
Phone No -
Integrator:
Integrator• r ; twp"
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location or Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
❑ Other
Latitude: = f T Longitude: 04 01 = v
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Laver
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream lm acts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑
Dairy Cow
[]
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d_ Does discharge bypass the waste management system? (If yes, notify DWQ)
Z. 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
❑ NF
❑ Yes ❑ No NA
❑ NE
❑ Yes ❑ No NA
❑ NE
❑ Yes 1P No ❑ NA
❑ NE
❑Yes 'MNo El NA
❑NE
12128104 Continued

Facility Number: Date of Inspection 11
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
�iNo
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
N NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Idcntifier:
Spillway?:
Designed Freeboard (in):
ry
Observed Freeboard (in): 1
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ip Na
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
09 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
§i 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
0 Yes
O No
❑ NA ❑ NE
maintenance or improvement?
Waste A"lication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
FNo
❑ NA ❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes P No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Healy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or i0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window�❑ Evidence of Wind Drift El Application Outside of Area
12. Crop type /
s) -c?Ct �YMt Q V'Y� j „r SM • �'` ah-
13. Soil types) _/I- rZ i Le
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes M 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 fj 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):
A6
I
Reviewerlinspector Name Phone: RED 33-�3300
Reviewer/Inspector Signature: Date: /( elm,
LL/LO/VY a. vr�{ar�MCY

Facility Number: $ —'7� Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes QI-No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 6rNo ❑ NA ❑ NE
the appropiate box.
❑ WUP El Checklists El Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P 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
KNo
❑ 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
PNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
PNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
P No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
09No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
PNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
N 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
1!9 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
91 No
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
KNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
V1No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

r -
a
Type of Visit & Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral b Emergency 0 Other ❑ denied Access
Date of Visit: Arrival Time: Departure Time: �� County:Region: FiPd
Farm Name: __ _ &&stogy Owner Email:
Owner Name: Phone: ` /O- •?�'9- 3'/'25_ -
Mailing Address; . �re/� �i»� niQ,�.,a/,Q %pG _2�yS3
Physical Address:
Facility Contact: F�'anlC B/as.�..� Title:
Onsite Representative: _ron1 _A_%z�M
Certified Operator: Fr �d e o"
Back-up Operator:
Location of Farm.
Phone No:
Integrator v
Operator Certification Number:
Back-up Certification Number:
Latitude: [= o =1 Longitude: 0 ° = =
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
can to Feeder Qoa
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other --
❑ La er
❑ Non -La et
Dry Poultry
Nan -La
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
3
❑
Dairy Calf
❑
Dairy Heifer
j
❑
Dry Cow
i
❑
Non -Dairy
❑
Beef Stocket
❑
Beef Feeder
❑
Beef Brood Cowi
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
e. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (Ifyes, 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 9-Ko' ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
M-No
❑ NA
❑ NE
❑ Yes
04o
❑ NA
❑ NE
1.2128104 Continued

Facility Number: 8-) — p p
Date of Inspection - >
Waste Collection & Treatment
4. Is
,��,,�
storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
El Yes
EIN-
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?: A C)
Designed Freeboard (in): -,IS
Observed Freeboard (in): _ _� •
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
0<6
❑ 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?
[�es
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes EI 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 L✓J No ❑ NA ❑ NE
maintenance or improvement?
Waste Application ��,,/�
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes L'No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes LJ 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
- xo V - / 9 5` /OQ
12. Crop type(s) Ajo�n4I 11&_-
13. Soil type(s) L e_z �r A
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [� o ❑ NA ❑ NE
15_ Does the receiving crop and/or land application site need improvement? ❑ Yes ENo ❑ NA ❑ NEE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination, ❑ Yes,,�ooeU4 NA ,0114
17, Does the facility lack adequate acreage for land application? El Yes TQo A6 NA LSE
18. Is there a lack of properly operating waste application equipment? ❑ Yes G14o ❑ NA ❑ NE
Comments (refer to question;#} Egplam;yYES answers and/or arty recommendations or any outer comments.
Use drawings of fatuity to lietter'eaplatn stteta#zotis. (use addthon=al pages"asinecessaryj-
Pl�a3e Con' *q&,r 4o worst` Oct eS?5S�(iS�t'�9 9oOc� LJlpSS cover CJn /moan Lv6jl/f
Reviewer/Inspector Name*�� �' M _ tn.y Phone: g/O
Reviewer/Inspector Signature: Date: s`•id off
12128.104 Continued

1.17QJ
Facility Number: —1 Date of Inspection
Required Records & Documents ,-,�
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes P o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check 91!eS ❑ No ❑ NA ❑ NE
the appropirate box. � „�r Q�
El W� El C 0
ists -15esign El❑ �"'
21. Does record keeping need improvement? If yes, check the appropriate�ox below. ❑'Tes ❑ No El NA El NE
paste Applicat'on Elee tl OVa"saste Analysis �� ❑ veseltmrsfers ❑
❑ Stocking 91cropYield 120 Minute Inspections 9<onthly and I" Rain Inspections . reather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Kddltional g- meats, and/or` Drawings.
❑ Yes
❑ NA
❑ NE
ElYes
,EIP06
L446
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
QN
❑ Yes
No
❑ NA
D Tq
[-IYes['No
,❑,
❑ NA
NNE
❑ Yes
❑ No
❑ NA
,❑,
[9
❑ Yes U o ❑ NA ❑ NE
❑ Yes 94o ❑ NA ❑ NE
❑ Yes
3 No
❑ NA
❑ NE
❑ Yes
LJ No
❑ NA
❑ NE
❑ Yes
El"No
❑ NA
❑ NE
❑ Yes
Do
❑ NA
❑ NE
1-10- {
%ltasalate lagooh eg.9� ,n t�J'M /'rcoJ•tirr'[„j, PIeasG Se„c[ / ct GIr'le
Pv:lIE
Y
0 W O 0 Pf"Ce a C dP}, weW4, 30
pleast«'e Z[ G for, } ;e lyf Td/ .,, f r'' erjf Weu tr L o // O _I.P4-1
O J^/r� 1 P tQfL Per Tpy 420 fJ1.,�7V le- 7nslawcAP-75 W�en /J aeolP` 1 4r,'C Jn C7r.
�/�
a.'h .1T nsPto 4, !C•'h9 rC�Or�$ / r
(Gcaor G�iarT
t
work/, P/ras e
`Ake- a cvas1e sa„W1c. If Slyp No
-,rvar><e sa.yp/e
0/t 1e S 'rQ •�e6t+rq�v o0 �, &'.
sa""le
P•�•g �9 �CFur d�
4r4s �e [s{rt �, a acts ! %SsL
�+ /9 Nd � •'c a o f l/,'v�a �: o h r+ra y S�
r Dr e {a 5"""1&je.5
12125/U4

Type of Visit JP Compliance inspection U Operation Review U Structure Evaluation Q Technical Assistance
Reason for Visit 49 Routine O Complaint O Follow up O Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: I /Q } Arrival Time: Departure Time: D has County: r�,,,Pscn Region:
Farm Name: 6l t�✓Sd''1't 't'7G , Owner Email: �`��
Owner Name: F1' ari k
-6 O5,5,o 't� �} Phone:
Mailing Address: �$ G-MI —AVVI Oft Y4 :.Alice i,)C ,`[ -3
Physical Address: •�
Facility Contact: F(AIA V- t/1dS5OVn Title:
Onsite Representative:
Certified Operator: U
Back-up Operator:
Phone No:
Integrator (dq
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: a =1 1 ="
Longitude: = ° Q I = "
Swine
Design CurrentIll
Capacity Popnlation
Wet Poultry
Design Current
Capacity Population
Design Current
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
59 Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
❑ Feeder to Finish
o:
❑ Dairy Heifer
❑ Farrow to Wean
oultry
7
❑ D Cow
❑ Farrow to Feeder
Non-Dai❑
Farrow to Finish
ra
❑ Beef Stocker
Gilts
La erats❑Beef
70TurkeXy
Feeder
Boars
❑ Beef Brood CowlOPouets
ti; N .
❑ Other
)ther
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[A No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
50 NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
5& No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
Q9 No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: Date of Inspection
Waste Collection & Treatment T�
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0,No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No 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
[1 No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
® No
❑ NA ❑ NE
through a waste management or closure plan?
1
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
fpNo
❑ 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) Cm &Kn- Cn QW_,,-
13. Soil type(s) Cr,- B 1 LeA
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
N No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[51 No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
0 No
❑ NA ❑ NE
17_ Does the facility lack adequate acreage for land application?
❑ Yes
[gNo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�PNo
❑ NA ❑ NE
Commeizts (refer to question #) Explain any YES answers and/or any recommendations or any other comments:
Use drawings of facility to better ex lain situations. use additional es as necessa w '
Reviewer/inspector Name Phone: 9�
Reviewer/Inspector Signature: Date: /D
Page 2 of 3 12128104 Continued

Facility Number: 82 — Date of Inspection to
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 ® No ❑ NA ❑ NE
the appropriate box.
❑ WUP [I Checklists ❑Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ 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 [)q No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Ye No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
p 14Q
No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
PNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
29 No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
to 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?
El 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
[*t 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
Page 3 of 3 12128104

Type of Visit • Compliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit 49 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
F_ Facility Number Date of Visit: /' a( Time: i j0
Q Not O erational O Below Threshold
permitted GCer "hied [3 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: ... .�
Farm Name: .. - dC�;rQ .. _ ... ........� ._...�_ County:
Owner Name: L.. r fri� ........ ....... .: a�Saz? ./ _. - - - Phone No:
Mailing Address:..
Facility Contact: ........._..6.1,2A 5 #-PX. ..... Tit1e:............---------_.......... Phone No:
Onsite Representative: .__�i G� B�p�su"J _.... .._. Int tor:.. '7�j/ /
Certified Operator: .............. FCAMA._..... `_ �4st�� _................ Operator Certification Number:
Location of Farm:
EWine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 4 " Longitude a ' 66
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes KW6�
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑-Ko-
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes 0-Ko-
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 9-W
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 9-Mo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes QWo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 9-No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: _........ ............--------- _.......
Freeboard (inches): GJ It
12112103 Continued

` Facility Number: —1706 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 9'1'
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes [}moo'
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes M�Ko
8. Does any part of the waste management system other than waste structures require maintenancelmprovement? ❑ Yes 9-No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes 2-No
elevation markings?
Waste Ap0hcation
10. Are there any buffers that need maintenance!improvement? ❑ Yes Ergo
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes E,;Pdo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type �a�..,.,.�a . S...a // (r. n.., —
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
G-Ko
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
Q-Ko
b) Does the facility need a wettable acre determination?
❑ Yes
B'No
c) This facility is pended for a wettable acre determination?
❑ Yes
Q-N6
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
U-No
Odor Issues
IT Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
aNb
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
Rlq-0-
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes
0- 96
Air Quality representative immediately.
Comments (refer to qu�on #) E%Iarn aay�YFS answers and/or any iecommwdatsons cr any other comments. _ A _
�-r� h� i-�y -�" �- ' _� � �=-..-¢s5s. Y-•�+-6..n�_ .r.+ni.+..... a..t.�_`..__...t.F^^-_
Use dr wuigs of faciLty t betterexplarn srtaatons,�{usE addrbflnal pages as necessary){ eld COPY ❑ Final Notesrl
3 c
'�"Lc� " .:_�..z _'^�az: c : �i� �.._. __..�zc� � r �-'� n,. ' � s.:..:?N��,., �-. ��.^?-"F"«."�,"..".•,�.. =s.+z..� -- �=a �-c". µ, -ry
/, /
"trin � 3 7 , �h/
,n l 14rh77r W4Frl"3 , .r out of `J.s 5��.�r 1e/-4
2.
ZA
Reviewer/Inspector NameTg
Reviewer/Inspector Signature: Date: $T//-0
1�il��v� �.ansuusea

Facility Number: — p0 Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes [moo
22. Does the facility fail to have aA components of the Certified Animal Waste Management Plan readily available?
(ie/ c sts, sistl, , etc.) ❑Yes
23. Does record keeping need improvement? If yes, check the appropriate box below. gWes; ❑ No
911Waste Application [-}' ❑� Vaste Analysis ❑�vii• €itrg—
�-Y71,3 ����i,2
24. Is facility not in complian with any applicable setback criteria in effect at the time of design? ❑ Yes O-NO
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ❑ No
27. Did Reviewer/Inspector fail to discuss reviewfmspection with on -site representative? ❑ Yes g-No
28. Does facility require a follow-up visit by same agency? ❑ Yes QN6
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ❑-lft
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes ❑moo
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
*23 aNPc of fry a Gortty7t- a.r„fr s, fniple . Hd� nod h�oi a
611 fe Fe4arof7 JCoY, S4rsmPlef are GVPrtHT ' 0/, Gc1,O1ays 6eYroi,, v.r.f "PA., 5" o�r
d
P��aSC ronjp%le
14 e PAN
Gave /M'r Q%ssowt Mr, T,'.., Hal%s
R,^, Hal/ i / ept 1741,6rr 4 9/0-3.211- ygxy
12112103

.•
31 nos �i S�f n M
M Division of Water Resources
❑ Division of Soil and Water Conservation
❑ Other Agency
Facility Number: 820700 Facility Status: Active Permit- AWS820700
Inpsection Type: Compliance Inspection Inactive Or Closed Date:
Reason for visit: Routine County: Sampson Region:
Date of visit. 09/20/2017 Entry Time: 02:00 pm Exit Time: 3:00 pm Incident s
Farm Name: Blossom, tnc Owner Email:
Owner. Dm Farms Of Rose Hill LLC Phone:
Mailing Address: PO Box 1139 Wallace NC 284661139
Physical Address: 1238 Wilbur Pridgen Rd Harrells NC 28444
Facility Status: Compliant ❑ Not Compliant Integrator
Location of Farm: Latitude:
Murphy -Brown LLC
34- 41' 48"
❑ Denied Access
Fayetteville
910-285-1005
Longitude: 78' 18' 35"
from Harrells, take NC 41 South toward Whitelake, go about 7 miles and turn left onto SR 1120. Go 1.5 miles then turn right onto
SR1121 and go 0.2 miles to farm entrance on right.
Question Areas:
Dischrge 8 Stream impacts Waste Col, Stor, 8 Treat Waste Application
Records and Documents Other Issues
Certified Operator: Douglas Stephan Atkins Operator Certification Number: 985738
Secondary OIC(s):
On-Slte Representative(s): Name Title Phone
24 hour contact name Doug Atkins Phone:
On -site representative Doug Atkins Phone:
Primary Inspector: Bill Dunlap Phone:
Inspector Signature: Date:
Secondary Inspector(s):
Inspection Summary:
Calibration 5/15/2017 Sludge Survey N-4.6, 0-1.4 74%
Fields are cleaned up and well maintained. Stand is good but a little long in non target species, which is OK and long as they are
being baled and removed, Johnson Grass and Crabgrass will take up about as much as Bermuda. If you do not expect to control
these weedy grasses, get the plan changed.
Most improved farm in the system. Now get that sludge under control.
page: 1

Permit: AWS820700 Owner - Facility: Dm Farms Of Rose Full Facility Number. 820700
Inspection Date: 09/20/17 Inppection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations Design Capacity Current promotions
Swine
Swine - Wean to Feeder 7,800 7,800
Total Design Capacity: 7,800
Total SSLW: 234,000
Waste Structures
Disignated Observed
Type Identifler Closed Data Start Data Fre*board Freeboard
Lagoon 1 27.00 52.00
page: 2

Permit: AWS820700 Owner - Facility : Dm Farms Of Rose Hill Facility Number: 820700
Inspection Date: 09/20/17 Inpsecton Type: Compliance Inspection Reason for Visit: Routine
Discharttes & Stream Impacts
Yes
No Na Ne
1. Is any discharge observed from any part of the operation?
❑
0 ❑
❑
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
M ❑
❑
b. Did discharge reach Waters of the State? (if yes, notify DWQ)
❑
M ❑
❑
c. What is the estimated volume that reached waters of the State (gallons)?
d_ Does discharge bypass the waste management system? (it yes, notify DWQ)
❑
M ❑
❑
2. Is there evidence of a past discharge from any part of the operation?
❑
M ❑
❑
3. Were there any observable adverse impacts or potential adverse impacts to Waters of the
❑
M ❑
❑
State other than from a discharge?
Waste Collection, Storage & Treatment
Yes
No Na Ne
4. Is storage capacity less than adequate?
❑
M ❑
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (I.e.1 large
❑
M ❑
❑
trees, severe erosion, seepage, etc.)?
B. Are there structures on -site that are not properly addressed and/or managed through a
❑
■ ❑
❑
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
❑
0 ❑
❑
& Do any of the structures lack adequate markers as required by the permit? (Not applicable
❑
■ ❑
❑
to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑
M ❑
❑
maintenance or improvement?
Waste Application
Yes No Na No
10. Are there any required buffers. setbacks, or compliance altemabves that need
❑ M ❑ ❑
maintenance or improvement?
11. Is there evidence of incorrect application?
❑ M ❑ ❑
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
❑
PAN?
❑
Is PAN > 10%/10 lbs.?
❑
Total Phosphorus?
❑
Failure to incorporate manure/sludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
page: 3

Permit: AWS820700 Owner - Facility : Dm Farms Of Rose Hill Facility Number: 820700
Inspection Date: 09/20/17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Waste Application
Yaa No Na re
Crop Type 1
coastal Bermuda Grass
(Hay)
Crop Type 2
Coastai Bermuda Grass w!
Rye Overseed
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Leon
Soil Type 2
Candor
Soil Type 3
Soil Type 4
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste
❑
❑
❑
Management Plan(CAWMP)?
15. Does the receiving crop and/or land application site need improvement?
❑
❑
❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
❑
0 ❑
❑
determination?
17. Does the facility lack adequate acreage for land application?
❑
E ❑
❑
18. Is there a lack of properly operating waste application equipment?
❑
M ❑
❑
Records and Documents
Yea
No Na No
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑
S ❑ ❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑
E ❑ ❑
If yes, check the appropriate box below.
WUP?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Lease Agreements?
❑
Other?
❑
If Other, please specify
21. Does record keeping need improvement?
❑
❑ ❑
If yes, check the appropriate box below.
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
❑
Weather code?
❑
Rainfall?
❑
page: 4

op
Permit: AWS820700 Owner - Facility : Dm Farms Of Rose Hill Facility Number. 820700
Inspection Date: 09/20/17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents
Yes No No No
Stocking?
[]
Crop yields?
❑
120 Minute inspections?
❑
Monthly and 1" Rainfall Inspections
❑
Sludge Survey
❑
22. Did the facility fail to install and maintain a rain gauge?
❑
❑ ❑
23. If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment
❑
E ❑ ❑
(NPDES only)?
24_ Did the facility fail to calibrate waste application equipment as required by the permit?
❑
E ❑ ❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check the
❑
❑ ❑
appropriate box(es) below:
Failure to complete annual sludge survey
❑
Failure to develop a POA for sludge levels
❑
Non -compliant sludge levels in any lagoon
❑
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑
0 ❑ ❑
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
0 ❑ ❑
Other Issues
Yes No No No
28. Did the facility fail to properly dispose,of dead animals within 24 hours and/or document
❑
0 ❑
❑
and report mortality rates that exceed normal rates?
29. At the time of the inspection did the facility pose an odor or air quality concern? If yes,
❑
0 ❑
❑
contact a regional Air Quality representative immediately.
30. Did the facility fail to notify regional DWQ of emergency situations as required by Permit?
❑
N ❑
❑
(i.e., discharge, freeboard problems, over -application)
31. Do subsurface tie drains exist at the facility?
❑
0 ❑
❑
If yes, check the appropriate box below.
Application Field
❑
Lagoon / Storage Pond
❑
Other
❑
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or
❑
❑
❑
CAWMP?
33. Did the Reviewer/Inspector fail to discuss reviewAnspection with on -site representative?
❑
0 ❑
❑
34. Does the facility require a follow-up visit by same agency?
❑
E ❑
❑
page: 5