820470_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

type or visit. t jcom ante inspection V t)peranon Kevtew V btructure Evaluation V i ecntucat Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: 'S S Departure Time: County: Region: [(Z-O
Farm Name: 1'7 3 (,� ['ct j Gt t�� y Gc Ir''L� Owner Email:
Owner Name: ��� 3 p'� do( ��'IFt "N �,C Phone:
Mailing Address:
Physical Address:
Facility Contact: C 4,.:h5- ��t ✓ W C C{ L Title:
Onsite Representative: f l
Certified Operator: (f- f G[t� ba_ N e
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: a g
Certification Number:
Certification Number:
Longitude:
Design C►urrent
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity PopH.
Wean to Finish
Layer
DairyCow
Wean to Feeder
]Non -Layer
Dai Calf
Feeder to Finish ( i
Daia Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
Farrow to Finish
D . P,oultt,
Layers
Ca aci
P.o
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Gilts Non -Layers
Boars
Pullets
Y
Other ., -..
Turkeys
Turkey Poults
Other
Other
Discharges and Stream Imnacts
1. Is any discharge observed from any part of the operation? [] Yes M Ko ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes [] No 00AA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR) ❑ Yes [-]No EOXA ❑ 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 ea"'N"A ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ®?Vo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes j No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

[Facility Number: d Date of Inspection: R
W 'ste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [] Yes ❑-N-6—[] NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 0 No Q.+M ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 7
5. Are there any immediate threats to the integrity of any of the structures observed'?
❑ Yes
G3'_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
[!fNo
[] 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
Q o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑-ITo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [:TNo ❑ 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): (f (:3 s &-- 0
13. Soil Type(s): l Isnr_V vde, �a �c,[51 ^o Y
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes'-ga
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[3' To
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[fMo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application'?
❑ Yes
[B o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[2 "ro
❑ NA
❑ NE
Renuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage &: Permit readily available?
❑ Yes
Eg-Nb
❑ NA
❑ NE
20. Does the facility fail to have all components of the CA WMP 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
[t�'ltlo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[_ o
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facili Number: D Date of inspection: KerR
24'. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
<_ ❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
[9.310__'❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26_ Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
Z'"'o ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[Z ❑ NA
❑ NE
Other Issues
28, Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
F,-Wo
❑ 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
Zlo
❑ 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
ETNo
❑ 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
La<o
0 NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CA WMP?
❑ Yes
[�No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
0No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
E'No
❑ NA
❑ NE
Comments (refer,to�gUestaona#) �Expliitn any.:YES. sttsWers and/or: any additional recommendations or any other. Comments 'i .
.,.,
Use drawings of heility'ta better explain -situations (use additional pages as necessary).
or b 3: S y7o
C-el -- Z (v- 3 e) a - 6 8 5
Reviewer/Inspector Name:
Reviewer/Inspector Signatu►
Page 3 of 3
Phone.C(10" U
Date: if 0-A
2/4f201

ypeO1 rMu: �a Umpllance Inspection v typerauuu Review V atructure Evaluation lJ tecnulcal Assistance
Reason for Visit: ('Routine O Complaint O Follow-up O Referral 0 Emergency Q Other O Denied Access
Date of visit: Arrival Time: Kv Departure Timp: p e7 County:_.2! `—
Farm Name: L ot��cticcc �a �'''t' Owner Email:
Owner Name: } fo �� �cryvt� g B` t `1 lGc✓y(� y Phone:
Mailing Address:
Physical Address:
Facility Contact: Cy , 3 13 Title:
Ousite Representative: (
Certified C Operator: be am e- _
Back-up Operator:
Location of Farm: Latitude:
Phone:
Region:T72
7r-C 3
Integrator: A �y S
v
Certification Number: W W.
Certification Number:
Longitude:
Design Current
Design ,Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity P,ap..
Cattle Capacity Pop.
Wean to Finish
La er
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
�(, -- p—
DairyHeifer
Farrow to Wean
Design Current
D Cow
Farrow to Feeder
D . Poult .
Ca aci I;a
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Othcr
Discharges and Stream Impacts
_ 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 P No ❑ NA ❑ NE
❑ Yes ❑ No [3-NA ❑ NE
❑ Yes [:]No [4-NA ❑ NE
❑ Yes ❑ No
❑ Yes D o
❑ Yes [-No
[J'NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: jDate of In ection: G
1
Waste Collection & Treatment
4.7s storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[D-No❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[D-N-X�❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier;
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): E-{
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
0`1 o
❑ 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
EaNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[]N
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[:]Yes
❑'1 fro
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑`NIo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [2fNo ❑ 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): 6 ry.,tta_A, ry-sc -c,^ �I 1 b S 6 o
t 3. Soil Type(s); �.� r�„ !` t� /1 6A
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
E�J`&o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
0 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
El No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[3- Vo
❑ 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
�o
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design [-]maps ❑ pease 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 I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[]'1Vo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
0 No
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Facili Number: - 0 1 Date of Ins eetion: .Cj_
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes C4 rv° ❑ NA ❑ NE
A Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes � ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes D-4o [] NA ❑ NE
1
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [I Igo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [:]Yes �o ❑ 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 Ale ❑ 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 Q Yes to ❑ 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
9 1�10
❑ NA
❑ NE
❑ Application Field ❑ L agoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[allo
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
e'No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[2-Mo
❑ NA
❑ NE
4!�Gc q to i a,- , r I S--16
Reviewer/inspector Name:
Reviewer/Inspector Silmature
Page 3 of 3
al:D es as necessai
'V add -� I- r3 4(o
CAI
lI �Lk
Phone:` ( 33_333�
Date: 0
21412015

Environmental
Quality
14D3 Farms of the Carolinas, LLC
HD3 Lucas Dairy Farm
P. O. Box 535
Elizabethtown, NC 28337
RECEIVED
DEQIDWR
JUL 18 2017
WQROS
FAYETTEVILLE RF[;InNA! OFFICE
Dear HD3 Farms of the Carolinas, LLC:
July 14, 2017
ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
S. JAY ZEMNMRMAN
Director
Subject: Certificate of Coverage No. AWS820470
HD3 Lucas Dairy Farm
Swine Waste Collection, Treatment,
Storage and Application System
Sampson County
In accordance with your July 10, 2017 Notification of Change of Ownership, we are hereby forwarding to
you this Certificate of Coverage (COC) issued to HD3 Fames of the Carolinas, LLC, authorizing the
operation of the subject animal waste management system in accordance with General Permit AWG100000.
This approval shall consist of the operation of this system including, but not limited to, the management
and land application of animal waste as specified in the facility's Certified Animal Waste Management Plan
(CAWMP) for HD3 Lucas Dairy Farm, located in Sampson County, with a swine animal capacity of no
greater than the following annual averages:
Wean to Finish: Feeder to Finish: 7,116 Boar/Stud:
Wean to Feeder: Farrow to Wean: Gilts:
Farrow to Finish: Farrow to Feeder: Other:
If this is a Farrow to Wean or Farrow to Feeder operation, there may be one boar for each 15 sows. Where
boars are unnecessary, they may be replaced by an equivalent number of sows. Any of the sows may be
replaced by gilts at a rate of 4 gilts for every 3 sows.
This COC shall be effective from the date of issuance until September 30, 2019, and shall hereby void
Certificate of Coverage Number AWS820470 dated October 1, 2014. Pursuant to this COC, you are
authorized and required to operate the system in conformity with the conditions and limitations as specified
in the General Permit, the facility's CAWMP, and this COC. An adequate system for collecting and
maintaining the required monitoring data and operational information must be established for this facility.
Any increase in waste production greater than the certified design capacity or increase in number of animals
authorized by this COC (as provided above) will require a modification to the CAWMP and this COC and
must be completed prior to actual increase in either wastewater flow or number of animals.
Please read this COC and the enclosed State General Permit carefully. Please nav careful attention to the
record keening and monitoring conditions in this permit. Record -keeping forms are unchanged with this
General Permit. Please continue to use the same record keeping forms.
7`Not hi ng Compares-- - .
state of North Carolina I Environmental Quality I Division of Water Resources
Water Qnatity Regional Operations Section
1636 Mail Service Center I Raleigh, North Carolina 27699-1636
919-707-9129

if your Waste Utilization Plan (WUP) has been developed based on site -specific information, careful
evaluation of future samples is necessary. Should your records show that the current WUP is inaccurate
you will need to have a new WUP developed.
The issuance of this COC does not excuse the Pennittee from the obligation to comply with all applicable
laws, rules, standards, and ordinances (local, state, and federal), nor does issuance of a COC to operate
under this permit convey any property rights in either real or personal property.
Per NRCS standards a 100-foot separation shall be maintained between water supply wells and any lagoon,
storage pond, or any wetted area of a spray field.
Please be advised that any violation of the terms and conditions specified in this COC, the General Permit
or the CAWMP may result in the revocation of this COC, or penalties in accordance with NCGS 143-
215.6A through 143-215.6C including civil penalties, criminal penalties, and injunctive relief.
if any parts, requirements, or limitations contained in this COC are unacceptable, you have the right to
apply for an individual permit by contacting the Animal Feeding Operations Program for information on
this process. Unless such a request is made within 30 days, this COC shall be final and binding.
in accordance with Condition H.22 of the General Permit, waste application shall cease within four (4)
hours of the time that the National Weather Service issues a Hurricane Warning, Tropical Storm Warning,
or a Flood Watch associated with a tropical system for the county in which the facility is located. You may
find detailed watch/warning information for your county by calling the Raleigh, NC National Weather
Service office at [phone], or by visiting their website at: http;//www.weather.gov/rah/
This facility is located in a county covered by our Fayetteville Regional Office. The Regional Office staff
may be reached at 910433-3300. If you need additional information concerning this COC or the General
Permit, please contact the Animal Feeding Operations Program staff at [phone].
Sincerely,
ao� � .L
4
fior S. Jay Zimmerman, P.G.
Director, Division of Water Resources
Encies► tc (Gcncrai rnrmii ri�v'Gi VVVVVj
cc: (Certificate of Coverage only for all ccs)
Fayetteville Regional Office, Water Quality Regional Operations Section
Sampson County Health Department
Sampson County Soil and Water Conservation District
WQROS Central Files (Permit No. AWS820470)
Smithfield Hog Production

' r r
0 Division of Water Resources
❑ Division of Soil and Water Conservation
❑ Other Agency
Facility Number:
820470 Facility Status:
Inpsection Type:
Compliance Inspection
Reason for Visit:
Routine
Date of Visit:
0912212016 Entry Time: 09:00 am
Farm Name:
Form 2028
Owner:
Murphy -Brown LLC
Mailing Address:
PO Box 487
Active
Permit: AWS820470 [l Denied Access
Inactive Or Closed Date:
County: Sampson Region: Fayetteville
Exit Time: 10:00 am Incident d
Owner Email:
Phone: [phone]B00
Warsaw NC 28398
Physical Address: 650 Old Lucas Dairy Ln Turkey NC 28393
Facility Status: Compliant ❑ Not Compliant Integrator: Murphy -Brown LLC
Location of Farm: Latitude: 34' 57' 15" - Longitude: 78' 12' 51"
On south side of SR 1926. approx..4 miles from intersection with 1004.
Question Areas:
Dischrge & Stream Impacts Waste Col, Stor, & Treat Waste Application
Records and Documents Other Issues
Certified Operator. Bradley Devone Herring Operator Certification Number: 26545
Secondary OIC(s):
On -Site Representative(s): Name Title Phone
24 hour contact name Mike Norris Phone:
On -site representative Mike Norris Phone:
Primary Inspector: Robert Marble Phone:
Inspector Signature: Date:
Secondary Inspector(s):
Inspection Summary:
page: 1

Permit: AWS820470 Owner - Facility : Murphy -Brown LLC Facility Number: 820470
Inspection Date: 09/22/16 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations Design Capacity Current promotions
Swine
-Swine - Feeder to Finish 7,118
Total Design Capacity: 7,116
Total SSLW: 960,660
Waste Structures
Disignated Observed
Type Identifier Closed Date Start Date Freeboard Freeboard
tagoan
1
1900
45.00
Lagoon
2528
19M
page: 2

Permit: AWS820470 Owner - Facility : Murphy -Brown LLC Facility Number: 820470
Inspection Date: 09/22/16 Inppection Type: Compliance Inspection Reason for Visit: Routine
Discharges & Stream Impacts
Yes
No No Ne
1_ Is any discharge observed from any part of the operation?
❑
M ❑
❑
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
EIN
❑
b_ Did discharge reach Waters of the State? (if yes, notify DWQ)
❑
❑ M
❑
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑
❑
❑
2. Is there evidence of a past discharge from any part of the operation?
❑
3. Were there any observable adverse impacts or potential adverse impacts to Waters of the
❑
0 ❑
❑
State other than from a discharge?
Waste Goilection. Storage & Treatment
Yes No No No
4. Is storage capacity less than adequate?
❑
00
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (Le./ large
❑
0 ❑
❑
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a
❑
0 ❑
❑
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
(]
❑
8. Do any of the structures lack adequate markers as required by the permit? (Not applicable
❑
0 ❑
❑
to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑
M ❑
❑
maintenance or improvement?
Waste Application
Yes No Na N�
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ M ❑ ❑
maintenance or improvement?
11. Is there evidence of incorrect application?
❑ ❑ ❑
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
❑
PAN?
❑
Is PAN > 10%/10 lbs.?
❑
Total Phosphorus?
❑
Failure to incorporate manure/sludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
page: 3

Permit: AWS820470
Owner - Facility : Murphy -Brown LLC Facility Number: 820470
Inspection Date: 08/22/16
Inppection Type: Compliance Inspection Reason for Visit: Routine
Waste Application
Yes No Na No
Crop Type 1
Coastal Bermuda Grass
(Hay, Pasture)
Crop Type 2
Small Grain overseed
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Paxi iUe fine sandy loam
Soil Type 2
Wagram loamy sand, C to
6% 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
❑
s ❑
❑
Management Plan(CAWMP)?
15. Does the receiving crop andlor land application site need improvement?
❑
❑
❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
❑
M ❑
❑
determination?
17. Does the facility lack adequate acreage for land application?
❑
❑
❑
18. Is there a lack of properly operating waste application equipment?
❑
E ❑
❑
Records and Documents
Yes No Na
19. Did the facility fail to have Certiftcate of Coverage and Permit readily available?
❑ M [] ❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑ M ❑ ❑
If yes, check the appropriate box below.
WUP?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Lease Agreements?
❑
Other?
❑
If Other, please specify
21. Does record keeping need improvement?
❑ ❑ ❑
If yes, check the appropriate box below.
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
❑
Weather code?
❑
Rainfall?
❑
page: 4

Permit: AWS820470 Owner- Facility : Murphy -Brown LLC Facility Number: 820470
Inspection Date: 09/22/16 Inpsection Type. Compliance Inspection Reason for Visit: Routine
Records and Docurnen
Yes
No Na Ne
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?
❑
moo
23. If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment
❑
N ❑
❑
(NPDES only)?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
moo
25, Is the facility out of compliance with permit conditions related to sludge? If yes, check the
❑
000
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?
110110
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
E ❑
❑
Other Issues
Yes No Na No
2& Did the facility fail to.propedy dispose of dead animals within 24 hours and/or document
❑
E ❑
❑
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,
❑
M ❑
❑
contact a regional Air Quality representative immediately.
30. Did the facility fail to notify regional DWQ of emergency situations as required by Permit?
❑
0 ❑
❑
(i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility?
❑
■ ❑
❑
If yes, check the appropriate box below,
Application Field
❑
Lagoon / Storage Pond
❑
Other
❑
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or
❑
0 ❑
❑
CAWM P?
33. Did the Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑
M ❑
❑
34. Does the facility require a follow-up visit by same agency?
0
E ❑
❑
page: 5

Facility Number. 820470
Division of Water Resources
QDivision of Soil and Water Conservation
Other Agency
Active Permit; AWS820470 ❑ Denied Access
Inpsection Type: Compliance Inspection Inactive Or Closed Dale:
Reason for Visit: Routine County: Sampson Region: Fayetteville
Date of Visit: 11l0612015 Entry Time: 08:30 am Exit Time: 9:30 am Incident fl
Farm Name: Farm 2028 Owner Email:
Owner: Murphy -Brown LLC Phone: [phone]
Mailing Address: PO Box 487 Warsaw NC 28398
Physical Address: 650 Old Lucas Dairy Ln Turkey NC 28393
Facility Status: Compliant ❑ Not Compliant integrator: Murphy -Brown LLC
Location of Farm: Latitude: 34' 57' 15" Longitude: 78' 12' 51"
On south side of SR 1926, approx..4 miles from intersection with 1004_
Facility Status:
Question Areas:
Dischrge & Stream Impacts Waste Col, Stor, & Treat Waste Application
Records and Documents Other Issues
Certified Operator: Bradley Devone Herring Operator Certification Number: 26545
Secondary OIC(s):
On -Site Representative(s): Name Title Phone
24 hour contact name Mike Norris Phone:
On -site representative Mike Norris Phone
Primary Inspector: Robert Marble Phone:
Inspector Signature: Date:
Secondary Inspector(s):
Inspection Summary:
page: 1

Permit: AWS820470 Owner - Facility : Murphy -Brown LLC Facility Number: 820470
Inspection Date: 11/06/15 Inppection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations Design Capacity Current promotions
Swine
Swine - Feeder to Finish 7,116
Total Design Capacity: 7.116
Total SSLW: 960,660
Waste Structures
Disignated Observed
Type Identifier Closed Date Start Date Freeboard Freeboard
Lagoon
1
19.00
38.00
Lagoon
2528
19.00
page: 2

Permit: AWS820470 Owner - Facility : Murphy -Brown LLC Facility Number: 820470
Inspection Date: 11/06/15 Inpsection Type Compliance Inspection Reason for Visit Routine
Discharges & Stream Impacts
Yes No Na No
1_ Is any discharge observed from any part of the operation?
❑
M ❑
❑
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
■ ❑
❑
b, Did discharge reach Waters of the State? (it yes, notify DWQ)
❑
M ❑
❑
c What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑
❑
❑
2. Is there evidence of a past discharge from any part of the operation?
❑M
❑
❑
3, Were there any observable adverse impacts or potential adverse impacts to Waters of the
❑
N ❑
❑
State other than from a discharge?
Waste Collection Storage & Treatment
Yes
No Na No
4, is storage capacity less than adequate?
❑
M ❑
Cl
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (Le.! large
❑
❑
❑
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not property addressed and/or managed through a
❑
M ❑
❑
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
❑
0 ❑
❑
8. Do any of the structures lack adequate markers as required by the permit? (Not applicable
❑
0 ❑
❑
to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑
M ❑
❑
maintenance or improvement?
Waste Application
Yes No Na No
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ 0 ❑ ❑
maintenance or improvement?
11. Is there evidence of incorrect application?
❑ M ❑ ❑
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
❑
PAN?
❑
Is PAN > 10%/10 Ibs,?
❑
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: AWS820470 Owner - Facility : Murphy -Brawn LLC Facility Number: 820470
Inspection Date: 11/06/15 1npsection Type: Compliance Inspection Reason for Visit: Routine
WastB Application
Yes No Na Ne
Crop Type 1
Coastal Bermuda Grass
(Hay, pasture)
Crop Type 2
Smal Grain Overseed
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
PaxviNe tine sandy loam
Soil Type 2
Wagram loamy sand, a to
8% 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?
❑
0 ❑
❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
❑
N ❑
❑
determination?
17. Does the facility lack adequate acreage for land application?
Cl
0 ❑
❑
18. Is there a tack 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?
❑
E ❑ ❑
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

Permit: AWS820470 Owner - Facility : Murphy -Brown LLC Facility Number: 820470
Inspection Date: 11/06/15 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents
Yes No Na No
Stocking?
❑
Crop yields?
❑
120 Minute inspections?
❑
Monthly and 1" Rainfall Inspections
❑
Sludge Survey
❑
22. Did the facility fail to install and maintain a rain gauge?
❑
E ❑
❑
23. If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment
❑
0 ❑
❑
(NPDES only)?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
0 ❑,
❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check the
❑
E ❑
❑
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?
❑
N ❑
❑
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 andlor 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?
❑
E ❑
❑
(i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility?
❑
■ ❑
❑
If yes, check the appropriate box below.
Application Field
❑
Lagoon / Storage Pond
❑
Other
❑
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or
❑
0 ❑
❑
CAWM P?
33. Did the Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑
0 []
❑
34, Does the facility require a follow-up visit by same agency?
❑
E0
❑
page: 5

Division of Water Resources
Division of Soil and Water Conservation
Other Agency
Facility Number
820470 Facility Status:
Active Permit: AWS820470
❑ Denied Access
Inpsection Type:
Compliance Inspection
Inactive Or Closed Dale:
Reason for Visit:
Routine
County: Sampson Region:
Fayetteville
Date of Visit:
1211612014 Entry Time: 02:30 pm
Exit Time: 1115 pm Incident 11
Farm Name:
Farm 2028
Owner Email:
Owner:
Murphy -Brown LLC
Phone:
910-296-1800
Mailing Address:
PO Box 487
Warsaw NC 28398
Physical Address:
650 Old Lucas Dairy Ln
Turkey NC 28393
Facility Status:
N Compliant ❑ Not Compliant
Integrator: Murphy -Brown LLC
Location of Farm:
On south side of SR 1926, approx_ .4 miles tram intersection with 1004,
Question Areas:
Dischrge & Stream Impacts
Records and Documents
Latitude: 34' 57' 15"
Longitude: 78' 12' 51"
Waste Col, Stor, & Treat Waste Application
Other Issues
Certified Operator: Bradley Devone Herring Operator Certification Number: 26545
Secondary OIC(s):
On -Site Representative(s): Name Title Phone
24 hour Contact name Mike Norris Phone :
On -site representative Mike Norris Phone:
Primary Inspector Robert Marble Phone:
Inspector Signature: Date:
Secondary Inspector(s):
Inspection Summary:
page: 1

Permit: AWS520470 Owner - Facility : Murphy -Brown LLC Facility Number: 820470
Inspection Date: 12/16/14 Inp5ection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations Design Capacity Current promotions
Swine
❑ Swine - Feeder to Finish 7,116
Total Design Capacity: 7,116
Total SSLW: 960,660
Waste Structures
Disignated Observed
Type Identifier Closed Date Start Date Freeboard Freeboard
Lagoon
1
1 g•
37M
Lagoon
2528
19.00
page: 2

Permit: AWSB20470 Owner- Facility Murphy -Brown Li Facility Number 620470
Inspection Date12/16/14 Inpsection Type Compliance Inspect}on Reason for Visit' Routine
Discharges $ Stream Impacts
Yes No Na No
1. Is any discharge observed from any part of the operation?
❑
M ❑
❑
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
❑ 0
❑
b. Did discharge reach Waters of the State? (if yes, notify DWQ)
❑
EIM
❑
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?
❑
s ❑
❑
3. Were there any observable adverse impacts or potential adverse impacts to Waters of the
❑
0 []
❑
State other than from a discharge?
Waste Collection, Storage & Treatment
Yes
No Na No
4_ Is storage capacity less than adequate?
❑
M ❑
❑
It yes, is waste level into structural freeboard?
❑
5 Are there any immediate threats to the integrity of any of the structures observed (I.e./ large
❑
■ ❑
❑
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a
❑
■ ❑
❑
waste management or closure plan?
7_ Do any of the structures need maintenance or improvement?
❑
❑
❑
8. Do any of the structures lack adequate markers as required by the permit? (Not applicable
❑
❑
❑
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 A lication
Yor No Ne Ne
10. Are there any required buffers, setbacks, or compliance alternatives 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%110 lbs.?
❑
Total Phosphorus?
❑
Failure to incorporate manure/sludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
page: 3

Permit: AWS82CL470 Owner - Facility : Murphy -Brown LLC Facility Number: 820470
Inspection Date: 12/16/14 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Waste Application
Yes No No Re
Crop Type 1
Coastal Bermuda Grass
(Hay, Pasture)
Crop Type 2
Small Grain Overseed
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Paxville
Soil Type 2
Wagram loamy sand, 0 to
695 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
❑ 0 ❑ ❑
Management Plan(CAWMP)?
15. Does the receiving crop and/or land application site need improvement?
❑ 0 ❑ ❑
16 Did the facility fail to secure and/or operate per the irrigation design or wettable acre
❑ 0 ❑ ❑
determination?
17. Does the facility lack adequate acreage for land application?
❑ 0 ❑ ❑
18. Is there a lack of properly operating waste application equipment?
❑ 0 ❑ ❑
Records and Documents
Yes
No No No
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑
0 ❑
❑
20. Does the facility fait to have a!I components of the CAWMP readily available?
❑
0 ❑
❑
If yes, check the appropriate box below.
WUP?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Lease Agreements?
❑
Other?
❑
If Other, please specify
21. Does record keeping need improvement?
❑
0 ❑
❑
If yes, check the appropriate box below.
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
❑
Weather code?
❑
Rainfall?
❑
page: 4

Permit: AWS820470 Owner - Facility : Murphy -Brown LLC Facility Number:
820470
inspection Date: 12/16/14 Inppection Type: Compliance Inspection Reason far Visit:
Routine
Records and Documents
Yes
No Na No
Stocking?
Cl
Crop yields?
❑
120 Minute inspections?
❑
Monthly and V Rainfall Inspections
13
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?
❑
M ❑
❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check the
❑
0 ❑
❑
appropriate box(es) below:
Failure to complete annual sludge survey
❑
Failure to develop a POA for sludge levels
❑
Non -compliant sludge levels in any lagoon
❑
List structure(s) and date of first survey indicating non-compliance:
2& Did the facility fail to provide documentation of an actively certified operator in charge?
❑
01111
27, Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
M ❑
❑
Other Issues
Ygs No Na Ne
28, Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑
M ❑
❑
and report mortality rates that exceed normal rates?
29. At the time of the inspection did the facility pose an odor or air quality concern? If yes,
I
❑
M ❑
❑
contact a regional Air Quality representative immediately.
30. Did the facility fail to notify regional DWQ of emergency situations as required by Permit?
❑
M ❑
❑
(i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility?
❑
M ❑
❑
If yes, check the appropriate box below.
Application Field
0
Lagoon 1 Storage Pond
❑
Other
0
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?
❑
0 ❑
❑
page: 5

0 Division of Water Resources
❑ Division of Soil and Water Conservation
El Other Agency
Facility Number:
820470
Facility Status: Active
Permit: AWS820470
Denied Access
Inpsection Type:
Compliance Inspection
Inactive Or Closed Date:
Reason for visit:
Routine
County:
Sampson Region:
Fayetteville
Date of Visit:
1211212013 Entry Time: 09:30 am Exit Time: 10:30 am Incident #
Farm Name:
Farm 2028
Owner Email:
Owner:
Murphy -Brown LLC
Phone:
910-296-1800
Mailing Address:
PO Box 487
Warsaw NC 28398
Physical Address:
650 Old Lucas Dairy Ln
Turkey NC 28393
Facility Status:
Compliant ❑
Not Compliant Integrator:
Murphy -Brown LLC
Location of Farm:
Latitude:
34' 57'15" Longitude:
78' 12' 51"
On south side of SR 1926, approx. ,4 miles from intersection with 1004,
Question Areas:
Dischrge & Stream Impacts
Waste Cal, Star, & Treat
Waste Application
Records and Documents
Other Issues
Certified Operator: dames Blake Moore Operator Certification Number: 26555
Secondary OIC(s):
On -Site Representative(s): Name Title Phone
24 hour contact name Mike Norris Phone
On -site representative Mike Norris Phone
Primary Inspector: Robert Marble Phone
Inspector Signature: Date -
Secondary Inspector(s):
Inspection Summary:
page: 1

Permit: AWS820470 Owner - Facility : Murphy -Brawn LLC Facility Number: 820470
inspection Date: 12/12/13 Inppection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations Design Capacity Current promotions
Swine
0 Swine - Feeder to Finish
Total Design Capacity:
Total SSLW:
Waste Structures
Disignated Observed
Type Identifier Closed Date Start Date Freeboard Freeboard
Lague, 1 18.00
Lagoon 2528 19.00
page: 2

Permit: AWS820470 Owner - Facility : Murphy -Brown LLC Facility Number: 820470
Inspection Date: 12112l13 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Discharges & Stream Impacts
Yes No Na Nip
1. Is any discharge observed from any part of the operation?
❑
❑
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
❑ M
❑
b. Did discharge reach Waters of the State? (if yes, notify DWQ)
❑
❑ M
❑
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑
❑ 0
❑
2. Is there evidence of a past discharge from any part of the operation?
[]
ME]
❑
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 He
4, Is storage capacity less than adequate?
13
❑
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (Le.l large
❑
■ ❑
❑
trees, severe erosion, seepage, etc.)?
6_ Are there structures on -site that are not properly addressed and/or managed through a
❑
0 ❑
❑
waste management or closure plan?
7_ Do any of the structures need maintenance or improvement?
❑
M ❑
❑
B. Do any of the structures lack adequate markers as required by the permit? (Not applicable
❑
M ❑
❑
to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑
❑
❑
maintenance or improvement?
Waste Application
Yes No Na Ne
10. Are there any required buffers, setbacks, or compliance alternatives 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 AWS820470 Owner - Facility Murphy -Brown LLC Facility Number
820470
Inspection Date: 12/12113 Inpsection Type Compliance Inspection Reason for Visit:
Routine
Waste Application
Yes No Na Ne
Crop Type 1
Coastal Bermuda Grass
(Hay, Pasture)
Crop Type 2
Small Grain Overseed
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Paxv{Ile line sandy loam
Soil Type 2
Wagram loamy sand,
0 to
696 slopes
Soil Type 3
Soil Type 4
Soil Type 5
Soil Type 5
14. Do the receiving crops differ from those designated in the Certified Animal Waste
❑ M ❑
❑
Management Plan(CAWMll
15. Does the receiving crop and/or land application site need improvement?
❑ 0 ❑
❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
❑ 0 ❑
❑
determination?
17. Does the facility lack adequate acreage for land application?
❑ 0 ❑
❑
18. Is there a lack of properly operating waste application equipment?
❑ 0 ❑
❑
Records and Documents
Yes No Na No
19, Did the facility fail to have Certificate of Coverage and Permit readily available?
❑ ■ ❑
❑
20 Does the facility fail to have all components of the CAWMP readily available?
❑ E ❑
❑
If yes, check the appropriate box below
WU P?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Lease Agreements?
❑
Other?
[]
If Other, please specify
21. Does record keeping need improvement?
❑ E ❑ ❑
If yes, check the appropriate box below.
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
❑
Weather code?
❑
Rainfall?
❑
page: 4

Permit: AWS820470 Owner - Facility : Murphy -Brown LLC Facility Number: 820470
Inspection Date: 12/12/13 Inssection Type: Compliance Inspection Reason for Visit: Routine
Record$ and Documents
Yes No Na Ne
Stocking?
❑
Crop yields?
❑
120 Minute inspections?
❑
Monthly and 1" Rainfall Inspections
❑
Sludge Survey
❑
22, Did the facility fail to install and maintain a rain gauge?
❑
0 ❑
❑
23. If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment
❑
0 ❑
❑
(NPDES only)?
24, Did the facility fail to calibrate waste application equipment as required by the permit?
❑
0 ❑
0
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check the
❑
0 ❑
❑
appropriate boxes) below:
Failure to complete annual sludge survey
❑
Failure to develop a POA for sludge levels
❑
Non -compliant sludge levels in any lagoon
❑
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑
M ❑
❑
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
0 ❑
❑
Other Issues
Yes No No No
28, Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑
■ ❑
❑
and report mortality rates that exceed normal rates?
29, At the time of the inspection did the facility pose an odor or air quality concern? If yes,
❑
■ ❑
❑
contact a regional Air Quality representative immediately.
30, Did the facility fail to notify regional DWQ of emergency situations as required by Permit?
❑
❑
❑
(i.e., discharge, freeboard problems, over -application)
31, Do subsurface tile drains exist at the facility?
[j
M ❑
❑
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?
[]
0 ❑
❑
34. Does the facility require a follow-up visit by same agency?
❑
0 ❑
❑
page: 5

Ii ype of visit: luompnance inspection U operation xevtew u structure e:vatuanon V t ecantcat Assistance I
Reason for Visit: 0 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Z lQ rrival Time: �`< p .ti Departure Time: o �t7D County: Region_
Farm Name: 2-83 Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: I Y(i k Ah-i i ' Title: Phone:
Onsite Representative: I R Integrator: W14
Certified Operator: J�{ d?��p Certification Number: 20'
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
ik.M—ijesi Current Design
Swine�Capactty Pop. Wet Poultry Capacity
Current y Design
Pap Cattle Capacity
Dairy Cow
Dairy Calf
Dairy Heifer
Current Dry Cow
airy
Current
Pap.
Wean to Finish
La er
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
$
,
]Non -Layer
Design
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets Beef Brood. Cow
Turkeys
-TurkEy Poults
Other
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
[] Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ 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 DWQ)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page l of 3 21412011 Continued

Facili Number: Date of Inspection: -77 t ; ,
WaAc 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
U NA
❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in),
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ .NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
R 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 0 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 n❑ Evidence of Wind Drift Application Outside of Approved Area
12. Crop Type(s): a [644,Syr^;
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
ii 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
f!fl No
❑ NA
❑ NE
Required_ Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes �U 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 F
No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes U No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �;No [DNA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: Date of Inspection:
24. Oid the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes �? No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
T
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes r_$1No ❑ NA ❑ NE
27. Did the facility tail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes ❑ No (l�OhNA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
T
❑ Yes {4No ❑ NA ❑ NE
`�T"'
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 MNo ❑ 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)
T
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below_
❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
T
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 No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No ❑ NA ❑ NE
Comments (refer to°question:#): Explain any;YES answers and/or,any-additional recommendatioWIF, ciimm, i ii
Use drawines of facility to better explain situations (use additional -pages as necessary)..
�c&,A re c%r`�-d 7l r
sou v S i �-el,
Reviewer/Inspector Name:
ReviewerlInspector Signature:
Page 3 of 3
Phone:
Date: L� f' Z'
21412011

Type of Visit: 40 Compliance Inspection 0 Operation Review 0 Structure Evaluation O 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: Departure Time: County: egion:
Farm Name: �Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
S
Facility Contact:
Onsite Representative: 'e/
Certified Operator:
Title:
Phone:
Integrator:
g*—hg� -
Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet PoWtry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
I 11-ayer
Dairy Cow
Wean to Feeder
I INon-Layer
I
Dairy Calf
Feeder to Finish
Daig Heifer
Farrow to Wean
Desigrt
Current
DEyCow
Farrow to Feeder
D F Poult .
Ca achy
PLo .
Non -Dairy
Farrow to Finish
I Layers
Non -La ers
1pullets
Turke s
Beef Stocker
Beef Feeder
Beef Brood Cow
Gilts
Boars
Qther
Turkey Pouets
Other
Other
Dischar%es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other_
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes �] No ❑ NA ❑ NE
[:]Yes
❑ No
[P NA
❑ NE
[] Yes
❑ No
`P NA
❑ NE
d_ Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No M NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters D Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

1+ cility Number: 141 - 467= Date of inspection: )pig I
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 e 6
Identifier: 1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 4
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Zn No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ WE
(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 to 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? T
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes M 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 ApplicationnOutside of Approved Area
12. Crop Type(s): cogs_& ar M Ct �C5 Drift , 67,i h
13. Soil Type(s): PX
, C/
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
IM No
T
❑ 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
7" No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
fo No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
rN No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box_
❑WUP [:]Checklists ❑Design [:]Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Tra sfers
❑ Rainfall 0 Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes T No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes `p No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Conrinaed

Facifi Number: jDate of Inspection: p
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 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:
25. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No 0 NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No
m and report mortality rates that were higher than noral?
5
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes T No
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fait to notify the Regional Office of emergency situations as required by the ❑ Yes `p No
permit? (i.e., discharge, freeboard problems, over -application) T
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below_ ❑ Yes No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other: T
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? 0 Yes No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? [:]Yes ® No
Reviewer/Inspector Name:
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Signature:
Page 3 of 3
/D i�
21412011

•
Type of Visit 0 Compliance Inspection U Operation Review (.) Structure Evaluation U Technical Assistance
Reason for Visit Id Routine O Complaint O Follow up Q Referral Q Emergency 0 Other ❑ Denied Access
Date of Visit: lif 0 Arrival Time: Departure Time: County: .'ter ' sue"'
Farm Name: �0,9— 0 3 Owner Email:
Owner Name: �L [knell ] ��ZVLAI 1 ..i/ Phone:
Mailing Address: 1
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator: oDre,
Phone No:
Integrator:
Operator Certification Number;
Back-up Operator: Back-up Certification Number:
Location of Farm:
Region: Flfw_
Latitude: ❑O =1 =u Longitude: =°= =
Design Current Design Current Design Current
Via.
Swine Capacity Population �i'e f?ouitr}y t p ctty Population Cattle Capacity Yopulanon
11111
❑ Wean to Finish
❑ La er
El Dai Cow
❑ Wean to Feeder
❑Non -La er
❑ Dairy Calf
Uf ceder to Finish
QQ
❑ Dairy Heifer
❑ Dry Cow
El Farrow to Wean
Dry Poultry
❑ Farrow to Feeder
❑ Layers
Non -Dairy
❑ Beef Stocker
❑ Farrow to Finish
❑Gilts
❑Non -La ers
❑ Beef Feeder
❑ Roars
❑ Pullets
❑ Turkeys
❑ Beef Brood Cow
other
❑ Turkey Poults
?Number of Structures:
❑ Other
❑ Other
Discharges & Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
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 P No ❑ NA ❑ NE
❑ Yes
❑ No
0 NA
❑ NE
❑ Yes
❑ No
[�NA
❑ NE
NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page 1 of 3
12128104 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'?
❑ Yes [PNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No NA El NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 ucture 6
T
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6w 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 ElNA [INE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes (r
o ❑ NA ❑ NE
El Excessive Ponding ❑ Hydraulic Overload El Frozen Ground El Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN a 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of A eptabie Crop Window Evidence of Wind Drift ❑ Application of Area
12.
Outside
r�
Crop type(s) �� �-t tr-(�4 4)C
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? ❑ YesfN
o ❑ NA El NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ YesNo
❑ NA [INE
17.
Does the facility lack adequate acreage for land application? Cl Yeso
ElNA ❑ NE
18.
is there a lack of properly operating waste application equipment? [IYeso
❑ NA ❑ NE
Comments (refer to question #) Explaru a►y YES answers and/or any recommendations or anyotkter comments ,*
Use drawings of facility to better explain situations. (use additional pages as necessary):
IReviewer/Inspector Name Y& Phone: I
Reviewer/Inspector Signature: Date: rr 141to-
121?8;104' Continued

Facility Number: — Date of Inspection r
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20_ Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �No ❑ NA ❑ NE
the appropriate box. ElWUp El Checklists ❑ Design El Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard [] Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
T No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
tp 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
t*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
allo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
'.,No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ yes
�gNo
❑ 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
JANo
❑ 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
VNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
o
[INA
ElNE
33.
Does facility require a follow-up visit by same agency?
[l Yes
rNo
❑ NA
❑ NE
Ad tiousl Coa>tments snd4-'='
Page 3 of 3 12178104

Division of Water Quality
'Facility Num�Dgig ion of Soil and Water Conservation
Q 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 or, Visit: ll D/ D5 I Arrival Time: / Departure Time: County: SQt"
Farm Name: F�tr, �� 2 00 S Owner Email:
Owner Name: AA we -A ji LLc Phone:
Mailing Address:
Physical Address:
E7QQ
Facility Contact: (224'V— Title: Phone No:
u �t�
Onsite Representative: Integrator:
Certified Operator:Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = o [= , � Longitude: ❑ c = C ❑ «
Swine
❑ Wean to Finish
Design Current
Capacity Population
Iiiiiiii
Design Current
Poultry Capacity Population
❑ Layer
❑ Non -Layer
Design Carrent
Cattle Capacity Population
❑ DairyCow
❑ DairyCalf
❑ DairyHeifer
El
Dry Poultry
❑ Cow
El Non -Dairy
❑ Layers
❑ Beef Stoecker
❑ Non -Layers
❑ Beef Feeder
❑ Pullets
❑ Beef Brood Cowl
❑ Turke s
Other
❑ Other
❑Turke Poults
❑Other
Number of Structures:
❑ Wean to Feeder
Discharges
Feeder to Finish
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Gilts
PH3Boars
Region:
&Stream Impacts
1. is any discharge observed from any part of the operation?
❑Yes
tqNo
❑ NA
❑ NE
Discharge originated at: ❑Structure [I Application Field ❑Other
a. Was the conveyance man-made?
❑Yes
❑ No
�Q NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify QWQ)
❑Yes
❑ No
i29NA
❑ 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
PNA
❑ NE
2_ Is there evidence of a past discharge from any part of the operation?
❑Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
No
❑ NA
❑ NE
other than from a discharge?
12/18/04
Continued

Facility Number: 7Q Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
P NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 1✓ 1!
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 io
❑ NA ❑ NE
through a waste management or closure plan? 4
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 EpNo
❑ NA ❑ NE
S. Do any of the stuctures Iack 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 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?
1 1 _ Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes V No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen GTOund ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [--IPAN > 10% or ] O lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside ofAcceptable Crop Window ❑ Evide a of Wind ❑ Application Outside of Area
12. Crop types) Q `W
/Drift
� f
C Ec- 5 IS4 r�� r r% _ , A
13. Soil type(s) '(,&)c yt I (tO -.Fj( 1 tA-ht;)trztlh
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
W No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
IM No
El NA
El 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
No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
1�1No
❑ NA
❑ NE
Comments (refer to question''#) �xExplain any YES answer`s andlor any recommendattoos or ny other comments
Use drawings'of facility to better explain situations. (use,additionai pages as necessary): ����
Reviewer/Inspector Name (V�a �� j ,. ''`
' _.� �., Phone:
Reviewer/Inspector Signature: Date: r AD
12128104 ' Continued

� T
Facility Number: g Date of Inspection i O
Re aired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes JoNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [$ No &I -NA ❑ NE
El❑
the appropriate box. ( _ `/{f"}I�'
WUP Checklists ❑Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain raainbreakers 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 phosphors 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?
❑ Yes
No
F
❑ NA
❑ NE
❑ Yes
�PNo
❑ NA
❑ NE
❑ Yes
qNo
❑ NA
❑ NE
❑ Yes
�3 No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
PNo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes]
No
❑ NA
❑ NE
❑ Yes
E�No
❑ NA
❑ NE
❑ Yes
'EPNo
❑ NA
❑ NE
12128104

Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason far Visit *Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: j Arrival Time: D.7% Departure Time: p3 County: Region:
Farm Name: _ �S Q Owner Email:
Owner Name: wc� Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
�
to �� �
Onsite Representative:T Integrator: "Y� Ly2-7 i, C
Certified Operator: `�-5 e_ Operator Certification Number: a(
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = & [=64 Longitude: 0 ° 0 I 0 u
Design Current
esiga Current
RoomyA
Design Current
Swine Ca aci Po ulation
Wet a Po ulation
h' P
Cattle Ca acimow,
P ty P
.
❑ Wean to Finish
.P -_
Dairy Cow
❑ Wean to Feeder
❑Non -La er
❑ DaiEy Calf
Feeder to Finish
. K
❑Dairy Heifer
Farrow to Wean
Dry PouEtry -
❑ Dry Cow
El Farrow to Feeder
_
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑Non -La ers
❑ Beef Feeder
❑ Boars
[] Pullets
❑ Beef Brood Co
-,
❑ Turke s
-
❑ Other
❑ Turkey Poults
❑ Other
Npm6:er of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
❑ Yes
❑ No
IN NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
P No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
ip No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: — Q Date of Inspection
Waste Collection & Treatment
4. Is storage Capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: i
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑Yes VNo ❑NA ❑NE
❑ Yes ❑No ;;tNA ❑ NE
Structure 5 Structure 6
❑ Yes n No ❑ NA ❑ NE
❑ Yes 130 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 9 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 [I 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 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(sC005-1 ,l Q SQU-P44 -e _<ffl. Ayl- g/,!/!��!>
13. Soil type(s)y �L —YjC .40 ­3 , = _ G A6r -mil
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? [] Yes
1P No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
IQ No
❑ NA ❑ NE
@omments AN
(refertto;,gaeshon #)�platR�any YE5rfllff.�erstandlor any recommendations or any other comments.
,�.w -.
Ilse drawings of lacility4ol better�eaplaut situations t�(nse•addtlao'n�al�p�agges�"$s necessary):
.i~� �IiiirvM;i�`r+"`Ffi.YiVY►.
Reviewer/inspector Name Phone: 910 F 3 _
Reviewer/Inspector Signature: Date:24
Page 2 of 3 12178104 Continued

Facility Number:RZ Date of Inspection I �ar12� ri /�/7►0}
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ Grp ❑ Checklists ❑ Desig
n ❑Maps ❑Other
❑ Yes
99 No
❑ NA
❑ NE
❑ Yes
IgNo
❑ NA
❑ NE
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes [�] No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
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 ReviewerMspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency'?
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
t9 No
❑ NA
❑ NE
El Yes
E9No
❑NA
ONE
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
MNo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
DiNo
[I NA
[I NE
❑ Yes
P9 No
❑ NA
❑ NE
❑ Yes
&No
❑ NA
❑ NE
❑ Yes
J9 No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page 3 of 3 12128104

%J Division of Water Quality
FFac7ifiNumber �EZ Q
0 Division of Soil and Water Conservation
C1 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: 3 orl Arrival Time: Oil Departure Time: County: _ 5#0(Tv-'1 QS0J Region: FPO
Farm Name: /�10P,V-5 Q Owner Email:
Owner Name: ± " t I'�✓�' �t W W N Phone:
Mailing Address:
Physical Address:
Facility Contact: __ &4A C6W Y-- Title: Phone No:
N rr
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = ' = « Longitude: = ° = 1 = u
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
y ❑ Nan -La et
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouts
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Cattle
Design Current
Capacity. :,Population, -
❑
Daia Cow
❑
Daia Calf
❑
Daia Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cowl
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
J
❑ Yes M-No ❑ NA ❑ NE
❑ Yes
❑ No
[PNNA
❑ NE
❑ Yes
❑ No
P NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
1�No
❑ NA
❑ NE
❑ Yes
1B No
❑ NA
❑ NE
12128104 Continued

- r Facility Number: Date of Inspection
Waste Collection & Treatment
4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
P NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
In No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
EP 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
05'No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
PNo
❑ 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 ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable{❑ Application Outside of Area
Crop Window El Evidence of Wind
jDrift
12. Crop type(s) &r ntA Q l�l ! " �t � �P t', 5P^ -
Wa.,j.
13. Soil type(s) 9,1C
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
fi�No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
EPNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[--] Yes
EPNo
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
PNo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
IM 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):
C.
Reviewer/inspector Name � Phon :
Reviewer/inspector Signature: Date. 3f `7
12128104 Continued

Type of Visit i♦ Compliance Inspection Q Operation Review O Structure Evaluation U Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I f6_1 SW Arrival Time: Departure Time: County: ► 001 Region:
Farm Name: a�a'� 0-z'g 1) Owner Email:
Owner Name: W In Phone:
Mailing Address:
Physical Address:
Facility Contact: T►- QI=C Title:
u
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:
integrator: AA L&Ce�brow in
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: a o ❑ I = " Longitude: El o = I 0
Design Current
Swine
Design
V F—H Poultry C+apacity
Current
Population
''1-11 Design Current
Caffi le C►apacity Population
❑ Wean to Finish
❑ La er
❑Dai Cow
❑ Wean to Feeder
❑Non -La er
❑Dai Calf
Feeder to Finish
`'
: � .�._�,._' '--.��:;;
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
r
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑Gilts
❑ Nan -La ers
❑ Beef Feeder
❑ Boars
ElPullets
Brood Col Beef
_
❑ Turkeys
...
�
Other
❑ Other
❑ Turkc Poults
❑Other
a'
y pA. I
"�Namber of Structures:
OHM
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
JP No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
rp
a. Was the conveyance man-made?
❑ Yes
No
PA
❑ NE
b_ Did the discharge reach waters of the State? (if yes. notify DWQ)
❑ Yes
❑ No
ERNA
❑ 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
PNA
❑ NE
2- Is there evidence of a past discharge from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
LP
El NA
❑ NE
other than from a discharge?
Page 1 of 3
1228104
Continued

e
Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [P No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [4 No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: `
Spillway?:
Designed Freeboard (in)_ /9
Observed Freeboard (in): 36
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
M1 No
[I NA El NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
171 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
`P No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
EANo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
No
❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of CropWindow El Evidence of Wind Drift ❑ Application Outside of Area
�Acceptable
12. Crop type�� �
s) Per-1-4% Gnze'ga,,, , ftA� tip , Sr.� c-,, -,,
13. Soil type(s) GC�t
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
;] No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
( No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Q9 No
❑ NA
❑ NE
Comments (refer to question # ): Explain any YES answers and/or any recommendations or any other comments
Use drawings,of facility to better explain situations. (use additional pages as.necessary):
Reviewer/Inspector Name j W ry e Y Phone>(no ?-3.2100
Reviewer/Inspector Signature: On Date: )9 7!C
Page 2 of 3 12128104 Continued

_ t
Facility Number: `� Date of Inspection L 170 p 1
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes PU No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAW MP readily available? If yes, check ❑ Yes M.No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps
p ❑ Other
21 _ Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes '� No El NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crap Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rain Inspections ❑ Weather Code
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
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
Rj No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
KI No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
R9 NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[M No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
0 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
0 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 t. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
$3 No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[P No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

1
Facility Number: Date of inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 1P No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes W No ❑ NA ❑ NE
the appropirate box.
❑ VVIJP ❑Checklists El Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 1()NNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
`tom No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
10 No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
$jNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
fpNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
5 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[�JNo
❑ NA
❑ NE
Other issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
1p No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[1 Yes
PNo
❑ NA
❑ NF
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
PNo
❑ NA
❑ NE
f yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
PNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
PNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
5No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

i
!� Division of Water. ' ualiI 1
Facility. Nufn�er $,� E Division of Soil and �t'ater Cooservat*on
©ther Agency
Type of Visit 0 Compliance Inspection Q Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit &Routine 0 Complaint 0 Fallow up 0 Referral Q Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region: Flo
Farm Name: rCZ(v+v L�J��/ Owner Email:
Owner Name: D � — -- _M1 L
APL C Phone:
Mailing Address: Pd 90%_ _ J
Physical Address:
Facility Contact:
Title:
Onsite Representative:t�a4
Certified Operator: _ - ?2 IGtY� 1. ULOL7�f'
Back-up Operator:
Phone No:
Integrator:. Aries -- �jh r ., r L"
Operator Certification Number: 24'.S-Ss'
Back-up Certification Number:
Location of Farm: Latitude: 0 n = ❑ « Longitude: = o =1 Q "
Swine
❑ Wean to Finish _
❑ Wean to Feeder
FerFinish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
Other
Design Current Design Current Design Current
Capacity 1'tipulat�on ; Wet.Paultry Capacity Population Cattle Capacity PoRi4d_6n1-;
Non -
'A
Dry Poultry
Ell -avers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance matt -made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
Beef Feeder
❑ Beef Brood Cou
.1
Number of Structures:
b" Did the discharge reach waters of the State? (If yes. notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes *o ❑ NA ❑ NE
❑ Yes
❑ No /&A
❑ NE
❑ Yes
❑ No &A
❑ NE
❑ No j�iA
❑ NE
❑ Yes
❑ Yes
Pl,�o ❑ NA
❑ NE
❑ Yes Kto ❑ NA ❑ NE
12128104 Continued

I Facility Number:
Date of Inspection r�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
❑ NA ❑ NE
XKNA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 fracture 6
Identifier:
Spillway?: kd
Designed Freeboard (in): ,I
Observed Freeboard (in): _
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ;No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [YNo ❑ NA ❑ NE
❑ Yes XNo
❑ Yes ❑ No
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes '"No ❑ NA [I 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 ❑ YesNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes V] No ❑ NA ❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes P6 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 Drill ❑ Application Outside of Area
12. Crop tyl s) _ .t-sv r •.rrc�f <I i:`r«:.����re:i+vrv�_ �,.�. r rrei..—�.te>"�
, a� �r.r.,r trr�
13. Soil type(s) qs (l&
14. Do the receiving crops differ from those designated in the CAWMP?
[--]Yes
b,No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
X Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination: ❑ Yes
A No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
N No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
6No
❑ NA
❑ NE
� � • IIt~� .-L�.ar� � � �t/� � t� �i� W G �� '.�.u->1�rP��� rd
`� Gi*``�• 9
LC1t>i TC? �a�-CC(. / e�7
3 11 i 1
Reviewer/Inspector Name �°
���
Phone:
Reviewer/Inspector Signature: -
Date:
C� '—

.FiciAty Number: Date of Inspection 9 �.
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 CA WMP readily available? If yes, check ❑ Yes 59 No ❑ NA ❑ NE
the appropirate box. ❑ Wes.- ❑ Checklists Cl Desi gtr El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [n No ❑ NA ❑ NE
❑ Waste Appticatimr ❑ Weekly Freeboard!❑ Waste Analysi< ❑ Soil Analysis ❑ Waste Transfei«S ❑ Annual Certification'
❑ Rainfalf ❑ Stocking- ❑ Crop Yielj4- ❑ 120 Minute InspectioK ❑ Monthly and V Rain Inspectioys ❑ Weather Code-
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
W No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
R] No
❑ NA
❑ NE
24_ Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[A No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
R] No
❑ NA
❑ NE
26_ Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
© No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
r
o
❑ 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
kNo
[I 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
V] 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
M No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
PNo
❑ NA
❑ NE
Ad�iiiodat fvo�aee©�s►ancllor Dravi� a s�'�' � �.:. ,' �`� y- ,.�'��
;2-1(. Far- Mares " ,._f -Nc' .
"f�-�� Cr•2fi r f7 rcc't�[
�r-f rq'3_70� i t�
-QC,.V or(- :2 IY ns� �
CY P release c �r eR_t � s �
12/28/04

Type of Visit • Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit • Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number S 5I 7D Mte of Visit: -'�-� Time:
O Not O rational O Below Threshold
'Permitted Sterdfied [3 Conditionally Certified 13 Registered Date Last Operated or Above Threshold: ••- .. ............
Farm Name: ...... F .2 S &_ ._........_.. ............ ..... - County:....._5 �:,. oso�s ............�_ ..... ! _.
Owner Name: r'"?.sa -._ ._..... r r� ku.? _. ... Phone No .
Maili
ng Address:..
Facility Contact: ...................—---------- -......._. Phone No:
Onsite Representative:..........._. __.� : k _ _. __ ._.- - -•. ...... Integrator:..._. °?�„�_�.? �. ?% .� .._ ._._
Certified Operator:._._.a 1. �6 , ,,.. ,1"15Q C2 _- Operator Certification Number:
Location of Farm:
(M Swine ❑ Poultry ❑ Cattle 0 Horse Latitude a 4 ft Longitude 0• 4 «
Disci & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [A No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min? N 14
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 0 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes M No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes jI No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ... _._._�...._.......... - _. _..__-- _ ... _....... - - .............,._ .. ..... _. .................. .......
Freeboard (inches):
12112103 Continued

ti Facility Number: �,, 2 — 4 7 b Date of Imspection
M i
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes ® No
closure plan?
(If any of questions 4.6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes No
elevation markings?
Waste Anulication
10. Are there any buffers that need maintenancelimprovement? ❑ Yes 10 No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes 0 No
❑ Excessive Pondtng ❑ PAN 3 Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type �J e � ..-, u, o� l � a L �� � S a � �, �. r ( r.. 1 i C �- � � 5 �� d � � r -j C_ -A
I3. Do the receiving crops differ with those designated in the Certified Animal Waste Management PIan (CAWMP)? ❑ Yes +Q No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes No
b) Does the facility need a wettable acre determination? ❑ Yes No
c) This facility is pended for a wettable acre determination? ❑ Yes EJ No
15. Does the receiving crop need improvement? Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes W No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ® No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes [51 No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes �No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes M No
Air Quality representative immediately.

Facility Number: g1 — y7p Date of Inspection
Renuired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
Yes No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes [!R No
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes EkNo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application) ❑ Yes ® No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes [,} No
28. Does facility require a follow-up visit by same agency? ❑ Yes JZ No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes [SINo
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) JM Yes ❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes 1XNo
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 Q rop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

s
Site Rewires Immediate Attention:
Facility No. -L - 4i ZD
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 76.ky z5 _, 1995
Time: i z '- 3 6-
Farm Name/Owner: L_-75
Mailing Address:a
County: S s o N
Integrator: CARRo�-i.S_ rrOpDS FA�trr-5 Phone: a - O t+-t 1
On Site Representative: ooa TS4ti*r Phone: C(+a - t
Physical Address/Location: ���- lcLaG c .l (rl_ e b c)_;-t
Type of Operation: Swine X Poultry Cattle
Design Capacity: c a a o Number of Animals on Site: + o
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon h sufficient freeboard of 1 Foot + 25 year 24 hour
(approximately 1 Foot + 7 inches)(Ye No Actual Freeboard: Z_ Ft. Inches
Was any seepage observed from the la n(s)9 Yes or No Was any erosion o ed? Yes or
Is adequate land available for spray? Yes r No Is the cover crop adequate? Yes or No
Crop(s) being utilized: L d
Does the facility meet SCS minimum setback criteria? 200 Feet from DweilinYes br No
storm event
No
100 Feet from Wells? [Yee,-* Qo
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? es or l Io
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes No
Is animal waste discharged into water of a state by man-made ditch, flushing system, or other
similar man-made devices? Yes o No If Yes, Please Explain.
Does the facility maintain adequate was management recor (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop}. Ye or No
Additional Comments: `:�' � r s
M,,tr{gML W %c.KE R
Inspector Name
Signature
-cc: Facility Assessment Unit Use Attachments if Needed.