820471_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

a._
t
M Division of Water Resources
El Division of Soil and Water Conservation
❑ Other Agency
Facility Number:
820471 Facility Status: Active
Permit AWS820471
Denied Access
Inppection Type:
Compliance Inspection
Inactive Or Closed Date:
Reason for Visit
Routine County:
Sampson Region:
Fayetteville
Date of Visit:
03/22/2017 Entry Tame: 10:30 am Exit Time: 11:00 am Incident i#
Farm Name:
2070
Owner Finall:
Owner.
Murphy -Brown LLC
Phone:
910-296-1800
Mailing Address:
PO Box 487
Warsaw NC 28398
Physical Address:
358 Salkcum Rd
Rose Hill NC 28458
Facility status:
Compliant ❑ Not Compliant Integrator
Murphy -Brown LLC
Location of Farm:
Latitude:
34° 48' 26" Longitude:
78' 17' 59"
On west side of SR 1138, approx. A miles from intersection with SR 1130.
Question Areas:
Dischrge 8 Stream Impacts Waste Col, Stor, & Treat
Waste Application
Records and Documents Other Issues
Certified Operator: Wayne 0 Sanderson
Operator Certification Number. 17903
Secondary OIC(s):
OnStte Representative(s): Nance
Title Phone
24 hour contact name Mike Ammons
Phone
On -site representative Mike Ammons
Phone
Primary Inspector. Robert Marble
Phone:
Inspector Signature:
Date:
Secondary Inspector(s):
Inspection Summary:
page: 1

B
Permit: AWS820471 Owner- Facility: Murphy -Brown LLC Facility Number. 820471
Inspection Date: 03/22/17 Inpsection Type: Compliance Inspection Reason for Visit Routine
Regulated Operations Design Capacity Current promotions
Swine
❑ Swine - Wean to Finish 7,990
Total Design Capacity: 7,990
Total SSLW: 918,850
Waste Structures
Disignated Observed
Type Identifier Closed Date Start Date Freeboard Freeboard
Lagoon
1
19.00
72.00
Lagoon
NEW #1
26.50
76.00
page: 2

Permit; AWS820471 Owner - Facility : Murphy -Brown LLG Facility Number: 820471
Inspection Date: 03/22117 Inppection Type: Compliance Inspection Reason for Visit: Routine
Discharges & Stream Impacts
Yea
No Na Na
1. Is any discharge observed from any part of the operation?
❑
0 ❑
❑
Discharge originated at -
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
❑ M
❑
b. Did discharge reach Waters of the State? (rf yes, notify DWQ)
❑
❑ 0
❑
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑
Elm
❑
2. Is there evidence of a past discharge from any part of the operation?
❑
0 ❑
❑
3. Were there any observable adverse impacts or potential adverse impacts to Waters of the
❑
■ ❑
❑
State other than from a discharge?
Waste Collection, Storage & Treatment
Yes
No Na Ne
4. Is storage capacity less than adequate?
❑
M ❑
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (Le./ large
❑
❑
❑
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?
❑
0 ❑
❑
8. Do any of the structures tack adequate markers as required by the permit? (Not applicable
❑
E ❑
❑
to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑
0 ❑
❑
maintenance or improvement?
Waste Application
Yes No No _Ng
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ ■ ❑ ❑
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 > 101/16/10 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: AWS820471 Owner - Facility : Murphy -Brown LLC Facility Number. 820471
Inspection Date: 03/22/17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Waste Application
Yea Na Na No
Crop Type 1
coastal Bermuda Grass
(Hay)
Crop Type 2
Small Grain Overseed
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Blanton sand, o to 6%
slopes
Soil Type 2
Wagram loamy sand, 4 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
❑
0 ❑
❑
Management Pian(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?
❑
❑
❑
Records and Documents
Yes No Na Ne
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑
0 ❑
❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑
0 ❑
❑
If yes, check the appropriate box below
WUP?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Lease Agreements?
❑
Other?
❑
If Other, please specify
21. Does record keeping need improvement?
❑ [] []
If yes, check the appropriate box below.
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
❑
Weather code?
❑
page: 4

Permit AWS82047 t Owner - Facility: Murphy -Brown LLC Facility Number 820471
Inspection Date: 03QV17 Inppection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents
Yea wg Na Ne
Rainfall?
❑
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 ❑
❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check the
❑
❑
❑
appropriate box(es) below:
Failure to complete annual sludge survey
❑
Failure to develop a POA for sludge levels
❑
Non -compliant sludge levels in any lagoon
[]
List structure(s) and date of first survey indicating non-ompliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑
E ❑
❑
27 Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
0 ❑
❑
Other Issues
Yss
No Na No
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,
❑
0 ❑
❑
contact a regional Air Quality representative immediately.
30. Did the facility fail to notify regional DWO of emergency situations as required by Permit?
❑
0 ❑
❑
(i.e discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility?
❑
0130
If yes, check the appropriate box below.
Application Field
❑
Lagoon I Storage Pond
❑
Other
❑
If Other, please specify
32_ Were any additional problems noted which cause non-compliance of the Permit or ❑ E ❑ ❑
CAWMP?
33. Did the Reviewer/inspector fail to discuss reviewlinspection with on -site representative? ❑ E ❑ ❑
34 Does the facility require a follow-up visit by same agency? ❑ 0 ❑ ❑
page: 5

Division of Water Resources
Division of Soil and Water Conservation
❑ Other Agency
Facility Number.
820471 Facility Status:
i4aive Permit: AVYS820471
❑ Denied Access
Inppection Type:
Compliance fnspection
Inactive Or Closed Date:
Reason for Visit:
Routine
County: Sampson Region:
Fayetteville
Date of Visit: 07/29/2015 Entry Time: 11:00 am Exit Time: 12:00 pm Incident #
Faun Name: 2070 Owner Email:
Owner. Murphy -Brown LLC Phone:
Mailing Address: PO Box 487 Warsaw NC 28398
Physical Address: 358 Balkcum Rd Rose Rill NC 28458
Facility Status: r Compliant ❑ Not Compliant Integrator: Murphy -Brown LLC
910-296-1800
Location of Farm: Latitude: 34' 48' 26" Longitude: 78' 17' 59"
On west side of SR 1138, approx..4 miles from intersection with SR 1130,
Question Areas:
Dischrge 8 Stream impacts Waste Col, Star, 8 Treat Waste Application
Records and Documents Other Issues
Certified Operator: Wayne O Sanderson Operator Certification Number: 17903
Secondary OIC(s):
On -Site Representative(s): Name Title Phone
24 hour contact name Mike Ammons Phone:
On -site representative Mike Ammons Phone:
Primary Inspector: Robert Marble Phone:
Inspector Signature: Date_
Secondary Inspector(s):
Inspection Summary:
page: 1

Permit: AWS820471 Owner- Facility : Murphy -Brawn LLC Facility Number: 820471
Inspection Date: 07129/15 Inspection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations Design Capacity Current promotions
Swine
Q Swine - Wean to Finish 7,990
Total Design Capacity: 7,990
Total SSLW: 918.850
Waste Stni. tures
Disignated Observed
Type Identifier Closed Date Start Date Freeboard Freeboard
Lagoon
1
i 9.OD
Lagoon
NEW #1
�8 5D
96.00
page: 2

Permit: AWS820471 Owner - Facility : Murphy -Brown LLC Facility Number:
820471
Inspection Date: 07/29/15 Inppection Type: Compliance Inspection Reason for Visit:
Routine
Dischargos & Stream Impacts
Yus
No Na No
1_ Is any discharge observed from any part of the operation?
❑
■ ❑
❑
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
❑ M
❑
b. Did discharge reach Waters of the State? (if yes, notify DWQ)
❑
❑ ■
❑
c What is the estimated volume that reached waters of the State (gallons)?
d, Does discharge bypass the waste management system? (if yes, notify DWQ)
❑
❑ M
❑
2. Is there evidence of a past discharge from any part of the operation?
❑
❑
D
3. Weiu 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 IN
4. Is storage capacity less than adequate?
❑
M ❑
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (I.e./ large
❑
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?
❑
0 ❑
❑
8. Do any of the structures lack adequate markers as required by the permit? (Not applicable
❑
■ ❑
❑
to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑
M ❑
❑
maintenance or improvement?
Waste Application
Yes No Na Ne
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ 0 ❑ ❑
maintenance or improvement?
11. Is there evidence of incorrect application?
❑ 0 ❑ ❑
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
❑
PAN?
❑
Is PAN > 10%I10 Ibs -?
❑
Total Phosphorus?
❑
FajEure to incofpofate manure/sludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
page: 3

Permit: AWS820471 Owner - Facility : Murphy -Brown LLC Facility Number: 820471
Inspection Date: 07/29/15 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Waste Application
Yes No Na No
Crop Type 1
Coastal Bermuda Grass
(Hay)
Crop Type 2
Small Grain Overseed
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Blanton
Soil Type 2
Wagram
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
❑
M ❑
❑
Management Plan(CAWMP)?
15. Does the receiving crop and/or land application site need improvement?
❑
❑
❑
16, Did the facility fail to secure and/or operate per the irrigation design or wettable acre
❑
❑
❑
determination?
17, Does the facility lack adequate acreage for land application?
❑
❑
❑
18, Is there a lack of properly operating waste application equipment?
❑
0 ❑
0
Records and Documents
Yas
No Na No
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑
M ❑
❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑
■ ❑
❑
If yes, check the appropriate box below.
WUP?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Lease Agreements?
❑
Other?
❑
If Other, please specify
21. Does record keeping need improvement?
❑
❑
❑
If yes, check the appropriate box below.
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
❑
Weather code?
❑
Rainfall?
❑
Stocking?
❑
page: 4

Permit: AWS820471 Dwner - Facility : Murphy -Brown LLC Facility Number: 820471
Inspection Date: 07/29/15 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents
yes No Na ke
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
❑
E ❑
❑
(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?
❑
E ❑
[]
27, Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
H ❑
❑
Other Issues
Yes
No Na Ne
28, Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑
❑
❑
and report mortality rates that exceed normal rates?
29, At the time of the inspection did the facility pose an odor or air quality concern? If yes,
❑
E ❑
❑
contact a regional Air Quality representative immediately.
30, Did the facility fail to notify regional DWQ of emergency situations as required by Permit?
❑
❑
❑
(i.e., discharge, freeboard problems, over -application)
31 _ Do subsurface file drains exist at the facility?
❑
, ❑
❑
If yes, check the appropriate box below.
Application Field
❑
Lagoon 1 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 Reviewerllnspector fail to discuss reviewfinspection with on -site representative?
❑
0 ❑
❑
34. Does the facility require a follow-up visit by same agency?
❑
E ❑
❑
page: 5

P r
M Division of water Resources
❑ Division of Soil and Water Conservation
❑ Other Agency
Facility Number.
820471 Facility Status:
Active Permit: AWS820471
❑ Denied Access
Inppection Type:
Compliance Inspection
Inactive Or Closed Date:
Reason for Visit:
Routine
County: Sampson Region:
Fayetteville
Date of Visit:
10/23/2014 Entry Time: 09:00 am
Exit Time: 10:00 am Incident #
Farm Name:
2070
Owner Email:
Owner:
Murphy -Brown LLC
Phone:
91D-296.180D
Mailing Address:
PO Box 467
Warsaw NC 28398
Physical Address:
358 Balkcum Rd
Rose Hill NC 28456
Facility Status:
0 Compliant ❑ Not Compliant
Integrator: Murphy -Brown LLC
Location of Farm: Latitude: 34° 48' 26" Longitude: 78° 17' 59"
On west side of SR 1138, approx..4 miles from intersection with SR 1130,
Question Areas:
Dischrge & Stream Impacts Waste Col, Stor, & Treat Waste Application
Records and Documents Other Issues
Certified Operator: Wayne O Sanderson Operator Certification Number: 17903
Secondary OIG(s):
On -Site Representative(s): Name Title Phone
24 hour contact name Mike Ammons Phone :
On -site representative Mike Ammons Phone:
Primary Inspector: Robert Marble Phone:
Inspector Signature: Date:
Secondary Inspector(s):
Inspection Summary:
page: 1

Permit: AWS820471 Owner - Facility : Murphy -Brown LLC Facility Number: 820471
Inspection Date: 10/23/14 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations Design Capacity Current promotions
Swine
Swine - Wean to Finish
Total Design Capacity: 7,990
Total SSLW: 918,850
Waste Structures
Disignated Observed
Type identifier Closed Data Start Date Freeboard Freeboard
Lagoon
1
19.00
Lagoon
NEW #1
26.50
83.00
page: 2

Permit: AWS820471 Owner - Facility : Murphy -Brown LLC Facility Number: 820471
Inspection Date: 10/23/14 Inppection Type: Compliance Inspection Reason for Visit: Routine
Discharges & Stream Impacts
Yes No Na No
1_ Is any discharge observed from any part of the operation?
❑
■ ❑
❑
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
[]
❑
b. Did discharge reach Waters of the State? (it yes, notify DWQ)
❑
❑ N
❑
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
❑
❑
❑
State other than from a discharge?
Waste Collection, Storage & Treatment
Yes No NiLNo
4. Is storage capacity less than adequate?
❑
0 ❑
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (LeJ large
❑
0 ❑
❑
trees, severe erosion, seepage, etc.)?
8. 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
❑
❑
❑
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 No Ng
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ M ❑ ❑
maintenance or improvement?
11. Is there evidence of incorrect application?
❑ M ❑ r]
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: AWS820471 Owner- Facility : Murphy -Brown LLC Facility Number:
820471
Inspection Date: 10/23/14 Inpsection Type: Compliance Inspection Reason for Visit:
Routine
Waste Application
Yes
No Na No
Crop Type 1
Coastal Bermuda Grass
(Hay)
Crop Type 2
Small Grain Overseed
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Blanton
Soil Type 2
Wagram
Soil Type 3
Soil Type 4
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste
❑
0 ❑
❑
Management Plan(CAWMP)?
15. Does the receiving crop and/or land application site need improvement?
❑
0 ❑
❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
❑
M ❑
❑
determination?
17. Does the facility lack adequate acreage for land application?
❑
❑
❑
18. Is there a lack of properly operating waste application equipment?
[l
0 ❑
❑
Records and Documents
Yes No Na No
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑
M ❑
❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑
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?
❑
3
Stocking?
❑
page: 4

Permit: AWS820471 Owner - Facility : Murphy -Brown LLC Facility Number:
820471
Inspection Date: 10/23/14 Inpsection Type: Compliance Inspection Reason for Visit:
Routine
Records and Documents
Yes No Na Me
Crop yields?
❑
120 Minute inspections?
❑
Monthly and 1" Rainfall Inspections
❑
Sludge Survey
❑
22. Did the facility fail to install and maintain a rain gauge?
❑
M ❑
❑
23. If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment
❑
❑
❑
(NPDES only)?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
0 ❑
❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check the
❑
0 ❑
❑
appropriate box(es) below:
Failure to complete annual sludge survey
❑
Failure to develop a POA for sludge levels
❑
Non -compliant sludge levels in any lagoon
❑
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑
❑
❑
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
❑
❑
Otherlssues
Yea No Na No
28, Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑
0 ❑
❑
and report mortality rates that exceed normal rates?
29, At the time of the inspection did the facility pose an odor or air quality concern? If yes,
❑
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 file drains exist at the facility?
❑
❑
❑
If yes, check the appropriate box below.
Application Field
❑
Lagoon / Storage Pond
❑
Other
❑
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or
❑
❑
❑
CAWMP?
33. Did the Reviewer/Inspector fail to discuss reviewlinspection with on -site representative?
❑
■ ❑
❑
34. Does the facility require a follow-up visit by same agency?
❑
M ❑
❑
page: 5

�❑ Division of Water Resources
Division of Soil and Water Conservation
El Other Agency
Facility Number:
820471 Facility Status:
Active Permit: AWS820471
Denied Access
Inppection Type:
Compliance Inspection
Inactive Or Closed Date:
Reason for visit:
Routine
County: Sampson Region:
Fayetteville
Date of Visit: 1211712013 Entry Time: 10:00 am Exit Time: 11:00 am
Farm Name: 2070
Owner Murphy -Brown LLC
Mailing Address: PO BOX 487
Incident#
Owner Email:
Phone: 91 D-296-1800
Warsaw NC 28396
Physical Address: 358 Balkcum Rd Rose Hill NC 26458
Facility Status: Compliant ❑ Not Compliant Integrator: Murphy -Brown LLC
Location of Farm: Latitude: 34° 48' 26" Longitude: 78' 1T 59"
On west side of SR 1138. approx..4 miles from intersection with SR 1130.
Question Areas:
Dischrge & Stream impacts Waste Col, Stor, & Treat Waste Application
Records and Documents Other Issues
Certified Operator: Carl Graham Lamb Operator Certification Number: 26849
Secondary OIC(s):
On -Site Representative(s): Name Title Phone
24 hour contact name Mike Ammons Phone:
On -site representative Mike Ammons Phone:
Primary inspector Robert Marble
Inspector Signature:
Secondary Inspector(s):
Inspection Summary:
Phone:
Date:
page: 1

Permit: AWS820471 Owner -Facility: Murphy -Brown LLC Facility Number: 820471
Inspection Date: 12117/13 Inspection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations Design Capacity Current promotions
Swine
❑ Swine - Wean to Finish
Total Design Capacity:
Total SSLW:
Waste Structures
Disignated Observed
Type Identifier Closed Date Start Date Freeboard Freeboard
Lagoon 1 19.00
Lagoon NEW#1 2650
page: 2

Permit: AWS820471 Owner - Facility : Murphy -Brown LLC Facility Number: 820471
Inspection Date: 12/17/13 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Discharges & Stream Impacts
Yes No Na Ne
1 _ Is any discharge observed from any part of the operation?
❑
0 ❑
❑
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
❑
❑
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)
❑
EIN
❑
2. Is there evidence of a past discharge from any part of the operation?
[]
❑
❑
3. Were there any observable adverse impacts or potential adverse impacts to Waters of the
❑
0 ❑
❑
State other than from a discharge?
Waste Collection Stora e & Treatment
Yes
No Na No
4. Is storage capacity less than adequate?
❑
M ❑
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (Le./ large
❑
❑
❑
trees, severe erosion, seepage, etc.)?
6. Are there structures on-sile 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?
❑
A Q
❑
B. 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
❑
MCI
❑
maintenance or improvement?
Waste Application
Yes No No we
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ 0 ❑ ❑
maintenance or improvement?
11. Is there evidence of incorrect application?
❑ 0 ❑ ❑
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
❑
PAN?
❑
Is PAN > 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 AWS820471
Inspection Date 12/17/13
Owner - Facility Murphy -Brown LLC Facility Number: 820471
Inppection Type Compliance Inspection Reason for Visit Routine
Waste Application
Yea No Na He
Crop Type 1
Coastal Bermuda Grass
(Hay)
Crop Type 2
Small Gram Qverseed
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Slanton sand, 0 to 6%
slopes
Soil Type 2
Wag ram loamy sand, 0 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
❑
N ❑
❑
Management Ptan(CAWMP)?
15. Does the receiving crop and/or land application site need improvement?
❑
❑
❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
❑
0 ❑
❑
determination?
17. Does the facility lack adequate acreage for land application?
❑
E ❑
❑
18. Is there a lack of properly operating waste application equipment?
❑
E ❑
❑
Records and Documents
Yos
No Na No
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑
❑
❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑
❑
❑
If yes, check the appropriate box below.
WU P?
❑
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?
❑
page: 4

Permit: AWS820471 Owner - Facility : Murphy -Brown LLC Facility Number 820471
Inspection Date: 12/17/13 Inpsection Type: Compliance Inspection Reason for Visit. Routine
Records and Documents
Yes
No No Ne
Rainfall?
❑
Stacking?
❑
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
❑
M ❑
❑
(NPDFS 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
❑
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?
❑
0 ❑
❑
27_ Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
M ❑
❑
Other Issues
Yes
No No No
28. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑
0 ❑
❑
and report mortality rates that exceed normal rates?
29- At the time of the inspection did the facility pose an odor or air quality concern? If yes,
❑
N ❑
❑
contact a regional Air Quality representative immediately.
30 Did the facility fail to notify regional DWQ of emergency situations as required by Permit?
❑
N ❑
❑
(i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility?
❑
a ❑
❑
It yes, check the appropriate box below.
Application Field
❑
Lagoon 1 Storage Pond
❑
Other
❑
If Other, please specify
32 Were any additional problems noted which cause non-compliance of the Permit or
❑
a ❑
❑
CAWMP?
33. Did the Reviewer/inspector fail to discuss reviewlinspection with on -site representative?
❑
■ ❑
❑
34. Does the facility require a follow-up visit by same agency?
❑
M ❑
❑
page: 5

Ii ype or v essu a Lompijancc inspection U vperatton tceveew U atrucrure r vaivanon v i ecanicai Assistance
Reason for Visit: 0 Routine O Complaint 0 Follow-up O Referral O Emergency 0 Other O Denied Access
Date of Visit. Arrival Time: neparture Time: (o :UDC County: 5A4'*&fj Region: )Cpa
Farm Name: p� Owner Email:
Owner Name: Wh Phone:
Mailing Address:
Physical Address:
Facility Contact: %r [ 46!&'o4_0 Title.
Onsite Representative: q
Certified Operator:
Back-up Operator:
Phone:
Integrator/. "
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
�,
Design Currentf,
Design Current
Design Current
Swtne
Capacity Pop..,f ,
Wet Poultry
Capacity
Pap
'Cattle Capacity Pap.
Wean to Finish
Wean to Feeder
L yer
Non -La er
I
D—airy Cow
Dairy Calf
)CIFeeder
to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
s,
D . P,oul
I Lavers
Desin
Ca aci
-
Current
Po P.
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
a '
Turke s
Other .
Poults
Other
_.TurkeX
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
�3 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
ERNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
© Yes
❑ No
O 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
K7k No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
F
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/4/1011 Continued

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?
El Yes
❑ No
� NA
❑ NE
Structure I structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Z�r
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[�j 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
[a 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
S. 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
la No
❑ NA
❑ NE
maintenance or improvement?
fFO
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[0 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes W 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 rCro%%p Window ❑ Evidence of Wind Drifter ❑ Application Outside of
Approved Area
12. Crop Type(s): - l �SS )� M' �(n Aa6eay
- --T 13. Soil Type(s): r w �
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [9 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Oj No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes EP No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [] Yes [P 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 P No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers [] Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes [P No ❑ NA ❑ NE
[] Yes Q� No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: Z- Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes � No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Q§ No ❑ NA ❑ NE
the appropriate box(es) below.
0 Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 0 No [DNA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
0 No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
MNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
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
EVNo
❑ 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/orfiany additional recommendations or any othertramments.'
Use drawings of facility_io:lietfer explain situations (use additional page's..as•necessary).
lied t 7 �710 Z
i S It I i2`
ReviewerAnspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: / -- 3W
Date: -i Z,
Z*2011

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 0 Denied Access
Date of Visit: 7I 't 1 Arrival Time: I D4=Q Departure Time: Q . D County: sA"4PW Region: A tD
Farm Name; b -7 c> 3 Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: fvTitle: �Pjhone:
� >�tim�
Onsite Representative: k integrator: i —1ky
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
. Design CnrrentDesign
Current
Design Current
Swine x _Capacity Pop.
Wet Pointry -Capacity Pop ;
Cathie Capacity Pop.
Wean to Finish
La er
iry Cow
Wean to Feeder
Non -La er
iry Calf
Feeder to Finish
- -
airy Heifer
Farrow to Wean
-"D g Cu`r'renf
D Cow
Farrow to Feeder
Dr, Poultr - ,Ga aclty P.o -
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non-C a ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other,_' . -
Turkey Poults
Other
Other
Discharges and Stream Impacts
l . Is any discharge observed from any part of the operation? ❑ Yes No 0 NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes No Qg NA ❑ NE
b_ Did the discharge reach waters of the State? (If yes, notify DWQ)
[:]Yes ❑ No
r 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 1 of 3 21412011 Continued

Facili Number: - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes rXNo ❑ NA ❑ NE
T
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No MINA ❑ NE
Structure I Structure 2 tructure 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 171 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 rM No ❑ NA ❑ NE
waste management or closure plan? L
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 r%No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes CP No ❑ NA [3 NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) T
9. Does any part of the waste management system other than the waste structures require ❑ Yes 1� No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes `P No ❑ NA ❑ NE
maintenance or improvement? T
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload [] Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Wiinnd,,ow� ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12_ Crop Type(s): t_VaS�( tI�-efHk� CMtrr C�71�., J. ►. �" �//�f
13. Soil Type(s): — p 4
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes P No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes f�j No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes P 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
1p No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists [-]Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
1P 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
EpNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
'� No
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facili Number: JE3A - / jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
25. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[:]Yes M No
❑ Yes [N No
(DNA ❑ NE
❑ NA ❑ NE
❑ NA
❑ NE
�NA
❑NE
❑NA
❑NE
❑NA ❑NE
❑ Yes `f"' No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Comments (refer to question#): Explain any YES answers and/or any additional recommend ations or, anylottier comments. .
Use:drawin s.. of facility to better explain situations (use additional pages as necessarY)
Q�CerdS re✓ie WA1111
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 9�4- Y33� 3'r
Date:
l/ /1011

Type of Visit & Compliance Inspection 0 Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit oRoutine O Complaint O Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: 1Q Departure Time: %/.� County: -^'�" Region:
Farm Name: 25-�A `""� q0 U; Owner Email:
Owner Name: v t�t� L� Phone:
Mailing Address:
Physical Address:
Facility Contact: ! Title:
N
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator IN r u_(,
Operator Certification Number:&�T
Back-up Certification Number:
Latitude: = o = L =is Longitude: = 0 0 ` = "
DesignMeurrent
Desigb Current
Design CurrentCaulation
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
r
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
Feeder to Finish
❑Dai Heifer
Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ La ers
El Non -Dairy
❑ Farrow to Finish
❑ Beef Stocker
❑ Gilts
❑Non -La ers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Other
❑ TurkeyPoults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [PNo ❑ NA ❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
[ NA
❑ NE
NA
❑ NE
❑ Yes
❑ No
❑ Yes
Ep No
❑ NA
❑ NE
❑ Yes
P No
❑ NA
❑ N E
Page I of 3 12178104 Continued

Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I StrRT
2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
c
Observed Freeboard (in):
❑ Yes T No
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
[PNA ❑ NE
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NF
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7_ Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuetures lack adequate markers as required by the permit? ❑ Yes [ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [] Yes 1� No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �No ❑ NA El 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 > i0%or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Cron Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CA WMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? ❑ Yes
17. Does the facility lack adequate acreage for land application'? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
$No
❑NA
❑NE
cp No
❑ NA
❑ NE
` 9 No
❑ NA
❑ NE
IV No
❑ NA
❑ NE
P No
❑ NA
❑ NE
Comments (refer to quesnvn q) Expliffi'any-YES answers and/or any recomrhendgttons or any outer eomroentS .
iJse drawrngs`of facility to better egplam;situaii6ns. (use additional pages as necessar3);
• Re" re-✓r`e�.t-��i ��-�r gyp.
Reviewer/Inspector Name - - —
p
- Phone: l o-Y 3r33CO
Reviewer/Inspector Signature:
Date: L9
12128104 Continued

Facility Number: NEMDate of Inspection
Renuired 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 appropriate box.
❑ WUP ❑Checklists El Design ❑Maps ❑ Other
❑ Yes
No
❑ NA
❑ NE
❑ Yes
Si
No
-❑ NA
❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield El120 Minute Inspections ❑ Monthly and I" Rain Inspections 1
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
No ❑ NA ❑ NE
1 Annual Certification
❑ Weather Code
❑ Yes
No ❑ NA
❑ NE
❑ Yes
A
totA
❑ NE
❑ Yes
�o
❑ NE
❑ Yes
❑ NA
iZ
❑ NE
❑ Yes
[] NA
❑ NE
❑ Yes UNo ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
4 No
[:3NA
ElNE
❑ Yes
( No
❑ NA
❑ NE
El Yes
No
❑NA
ONE
Page 3 of 3 I2128104

.I
Type of Visit *Compliance Inspection 0 Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit a Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 10
I r Arrival Time: Departure Time: County:
Farm Name: `� �S �' Owner Email:
Owner Name: f.U9/ Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Pbone No:
Onsite Representative:
Certified Operator: Oh
Back-up Operator:
I
Region: �_
Integrator: IV tU V'Q —Q vt7U3 -4-- LK-k—
Operator Certification Number: 1770-3
Back-up Certification Number:
Location of Farm: Latitude: ❑ 0 0 6 ❑di Longitude: [� ° ❑ 6 ❑
is
Design Current Design Current
Design Current
Swine Capacity Population Wet Poultry Capacity Population
Cattle C*apacity Population
Wean to Finish
❑ Laver
❑ Dairy Cow
El Wean to Feeder
I IFJ Non-Layer—J
Dairy Calf
❑ Dairy Heifer
❑ Feeder to Finish
❑ Farrow to Wean
Dry foul
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
Layers
ElNon
El Beef Stocker
Gilts
aers
❑ N-Layers
ElBeef Feeder
Boars
❑ Pullets
El Beef Brood COVA
Turkeys
Other ❑ TurkeyPoults
!Number of Structures:
❑ Other ❑ Other
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
F No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
0 NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
EP 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
lb NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
Cl Yes
11 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
q No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

` Facility Number: Date of Inspection "•'7`—�'J
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
99 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
NA
❑ NE
Structure 1 Structturre, 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: 0� 703 a� J
Spillway?:
Designed Freeboard (in):
u
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
P No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
to 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
T 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
[ONo
❑ 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 Evide a of Wind Drift ❑ Application Outside of Area
&W"12. Crop type(s)`-'r'4 �r f�
13. Soil type(s) 1j64fl. —
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
ONo
❑ NA
❑ NE
M No
❑ NA
❑ NE
No
❑ NA
❑ NE
QlNo
❑ NA
❑ NF.
qNo
❑NA
El NE
Use drawings:of facility to better ex n situation ., _ ..
Comments (refer to queshou #) Explain any YES ansaeirs antllor+any recommendations or anyother comments.
ty p s. (nsit addttio'n�a1,pages us �ecessa�iy,) li
IReviewer/Inspector Name 957 I - Phone:
Reviewer/inspector Signature: Date:
12/28/04 Continued

Facility Number: Date of Inspection Z`I
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 ElNA [INE
the appropriate box.
ElWIJP ❑Checklists El Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes O No [I NA [I NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26, Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the Facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
bONo
❑ NA
❑ NE
❑ Yes
❑ No
[PNA
❑ NE
[:]Yes
No
❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
❑ YestNo
No
❑ NA
❑ NE
❑ Yes ❑ No NA ❑ NE
❑ Yes
'C' No
❑ NA
❑ NE
❑ Yes
�9 No
❑ NA
❑ NE
❑ Yes
1p No
❑ NA
❑ NE
❑ Yes
k3 No
❑ NA
❑ NE
❑ Yes 10 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
12128104

Type of Visit Compliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine Q Complaint O Follow up Q Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name: rbB Owner Email:
Owner Name: I ' IWQ� Phone: _
Mailing Address:
Physical Address:
Region:
Facility Contact: viri VQ Title: Phone No:
C1
Onsite Representative: Integrator: A1,12r emw n L f
Certified Operator: a• _ 5�n Operator Certification Number: �3
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: ❑ e =' =" Longitude: = ° ❑ ' = «
Design Curren# Design Current. Design Current
"an
$wme Capacity Poulatioo�� Wet Poultry "C p cityPoptlatton Cattle Capacity Population
Wean to Finish r1CRO O ❑ Layer ❑ Dairy Cow
Wean to Feeder ❑ Non -La er I ❑ Dairy Calf
❑ Feeder to Finish w
❑Dai Heifer
T+f!+ `
❑ Farrow to Wean iMDi!ouY'� [3 D Cow
try ___:
[3 Farrow to Feeder ``" - -� Non -Dairy
El Farrow to Finish ❑ La ers
❑Beef Stocker
❑ Gilts ❑ Non -Layers ❑ Beef Feeder
❑ Boars � ❑Pullets ❑ Beef Brood Co
Turkey Points
F { ❑ Turke s ii p
Other t , ❑ ;.
Other h Dothe­r W Number 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
r NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
P 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
R, NA
❑ NE
2. Is there evidence ofa past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

�f ?
Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes V No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes [1 No
N NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: 2703 25be
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6, Are there structures on -site which are not properly addressed and/or managed
❑ Yes [� 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 DWO
7. Do any of the structures need maintenance or improvement?
❑ Yes Q1 No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes P 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 16 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA ElNE
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 l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
[:]Outside of Acceptable Crop Window ❑ Evidence of Wind Drift //❑Application Outside of Area
12. Crop types) cc S of�
13. Soil types)j1G[►^T�n—F���
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
q] No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
P No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
EP No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
`W No
❑ NA
❑ NE
Comments (refer ta�+quesan,#J �Epla any �.ES� an ers and/or arty recommepdatioas ar any other comments., ..:
Use drawings of factlity3to"betterezlilata�situation s (ns�e ad al pages asp
r I
1W
Reviewer/Inspector Name
= Phone: t
Reviewer/Inspector Signature:
Date:
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ®No ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists El Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes N No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes M 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
[$No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
MI No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
CR No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAN") certification?
❑ Yes
0§ No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[pNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
1P 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
19 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
0
❑ 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
V No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
1�9 No
❑ NA
❑ NE
Additional C-dinroents aradLor Drawings ; � x -e AMg %�-
i
+r
Page 3 of 3 12128104

ir
ti
0 Division of Water Quality
Facility Number O Division of Soil and Water Conservation
_ .... 1 - 0 Other Agency
Type of Visit • Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 4D Routine 0 Complaint 0 Follow up 0 Referral 0 Ern)Kgency 0 Other ❑ Denied Access
o.
Date of Visit: $ O `Arrival Time:
Farm Name: "1' _0 f?C_)
Owner Name: _ UWO na»y1
Mailing Address:
Physical Address:
Facility Contact: L22cfA wfrr Title:
Onsite Representative: V
Certified Operator. 011
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
: r
Region:.
Owner Email:
Phone:
,� Phone No:
M�p
Integrator: I''UMAL-1 &aon
Operator Certification Number: t f7 9a;
Back-up Certification Number:
Latitude: = o = 1 = u Longitude: ❑ ° ❑ ' ❑ k
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
F
La er Non -La ei
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current.��.
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
EFDry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
Beef Brood Co:.
Number of Structures: ;. r
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge'?
❑ Yes [PNo ❑ NA ❑ NE
❑ Yes
❑ No
T' NA
❑ NE
❑ Yes
❑ No
PNA
❑ NE
[ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
.59 No
❑ NA
❑ NE
12128104 Continued

` Facility Number: a t{r[. 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?
Sycture 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �i
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 14 No ❑ NA ❑ NE
❑ Yes ❑ No ,® NA ❑ NE
Structure 5 Structure 6
❑ Yes &No ❑ NA ❑ NE
❑ Yes ,B No ❑ NA ❑ NE
If any of questions 4-6 were answered ves, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 29 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 9) No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes n No ❑ NA ❑ NE
maintenance or improvement?
Waste Aolication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes P9 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect 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 Drifl ❑ Application Outside of Area
12. Crop type(s)
13_ Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
43 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
R3 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
M No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
AL
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date: ?
12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes P No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? if yes, check ❑ Yes IS No ❑ NA ❑ NE
the appropirate box.
Q WUP Q Checklists El Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0ONo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes P No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E9 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
Yes
No
❑ NA
❑ NE
26_
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
99 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[] Yes'
WNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[RNo
❑ 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
WNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
&No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

Type of Visit a Compliance inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit 0 Routine Q Complaint Q Follow up Q Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: l0 Departure Time: � s County: �a Region:��
llrrr r_ [2Q
Farm Name: �v l lS M � - _ Owner Email:
Owner Name: u''r�V` Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No: p
�jOnsite Representative: tr Integrator: row N ���
Certified Operator; Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 e = 4 [= « Longitude: E--1 ° =' = u
Design C►urrent
Swine Capacity Population
Design
W.et Poultry Capacity
Current Design Current
Population Cattle Capacity Population
❑ Wean to Finish
❑
La er
❑ Dairy Cow
❑ Wean to Feeder
❑
Non -Layer
❑ Daia Calf
❑ Feeder to Finish
Farrow to Wean
2
_
❑ Dairy Heifer
47-;L
❑ Beef Brood Co
- .=. -
it
El Turke Poults
Layers
❑
❑ Non -Layers
LEI] Pullets
❑ Turkeys
❑ Other
Discharges & Stream Im acts
l . Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure El Application Field El Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of
❑ Yes DTNo ❑ NA ❑ NE
❑ Yes ❑ No (�'•NA El NE
❑ Yes ❑ No � NA ❑ NE
❑ Yes ❑ No [�NA ❑ NE
❑ Yes 'B No ❑ NA ❑ NE
❑ Yes �3 No ❑ NA ❑ NE
1
2/28/04 Continued
Discharges & Stream Im acts
l . Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure El Application Field El Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of
❑ Yes DTNo ❑ NA ❑ NE
❑ Yes ❑ No (�'•NA El NE
❑ Yes ❑ No � NA ❑ NE
❑ Yes ❑ No [�NA ❑ NE
❑ Yes 'B No ❑ NA ❑ NE
❑ Yes �3 No ❑ NA ❑ NE
1
2/28/04 Continued
2/28/04 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
]NNo
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
VJ NA ❑ NE
Structure t Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: Z.S019 P,
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 1 U u
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
1P 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
RNo
❑ 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
MNo
❑ 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
W No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[B 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 I0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s)
13. Soil type(s) (1lt In 1 UjactlGl_hn
J
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
M No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
P0 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[P No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
P No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
$1 No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any othertieotnments.
Use drawings of facility to better explain situations. (use additional pages as necessary): `f
fi; r
Reviewer/I n specter Name ! � — �p t? Phon y3?`��?to
Reviewer/Inspector Signature:FQA Date: 96'7 Y-04
Page 2 of 3 12128104 Continued

Facility Number: — Z Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes P No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �] No ❑ NA ElNE
the appropriate box. r
❑ WUP ❑Checklists ❑Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes JRNo ❑ 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 7 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
P No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�j No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
�] No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
F NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[A No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
&9 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31 _
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
E�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
q, No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[3 No
❑ NA
❑ WE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

>_1
Type of Visit ® Compliance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: Arri-al Time: 2 :Y Departure Time: = b County: _ fct Region:
Farm Name: Z�t7 Owner Email:
Owner Name: Phone:
Mailing Address:O gdX _K4� i__� ?+� f� _ 28YSg
Physical Address:
Facility Contact: //++ Title:
Onsite Representative: _�, Ls..cr—
Certified Operator: — __Irje!tA C=_-s�
Back-up Operator:
Location of Farm:
.P+hone No:
Integrator: M; R73�Sr
Operator Certification Number: 2 �O
Back-up Certification Number:
Latitude: Elo = 1 = 1, Longitude: = o = ` = 4
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean Z f ZZ
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -La ei
Dry Poultry
❑ Lavers
❑ 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 man-made'?
Design Current
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
E]Non-Dairy
❑ Beef Stocket
❑ Beef feeder
❑ Beef Brood Co
Number of Structures: ®,
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes
[FNo
❑ NA
❑ NE
❑ 'Yes
❑ No
2fVA
❑ NE
❑ Yes
❑ No
KNA
❑ NE
[5NA
❑ NE
❑ Yes
❑ No
❑ Yes
[KNo
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
12128104 Continued

ncility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
N No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
J§NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?: H O
Designed Freeboard (in): 12
Observed Freeboard (in): .5-s
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[ANo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
BO 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
& Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
4 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
6No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
VSNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
El Yes
[.No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
13. Sail type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
5.No
❑ NA
❑ NE
15, Does the receiving crop and/or land application site need improvement?
Yes
-X No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination`
❑ Yes
P; No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[UNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
%No
❑ NA
❑ NE
00. —C'1.,a._ alrf
" % v_
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date:
12128104 Continued

acility Number; Date of Inspection Y o
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ER 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 appropiate box. ❑ WUIY ❑ Checklists ❑ Desigp. ❑ Mapa ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes B No ❑ NA ❑ NE
❑ Waste Applicatiw ❑ Weekly Freeboards ❑ Waste Analysie ❑ Soil Analys�r ❑ Waste Transfers ❑ Annual Certification/
❑ RainfalY ❑ Stocking ❑ Crop Yieldr ❑ 120 Minute Inspectioirs ❑ Monthly and. 1"Rain Inspection$/❑ 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
3 1. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
• Yes
9No
❑ NA
❑ NE
❑ Yes
[Q No
❑ NA
❑ NE
❑ Yes
[R No
❑ NA
❑ NE
❑ Yes
[R No
❑ NA
❑ NE
❑ Yes
S No
❑ NA
❑ NE
❑ Yes
B No
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
®,No
❑ NA
❑ NE
❑ Yes
Ff No
❑ NA
❑ NE
❑Yes
ZNo
❑NA
ONE
❑ Yes
P?.No
❑ NA
❑ NE
12128104

Facility Number al ©ate of Visit: (e /�?/ Tote.
B—N—atOperational O Below Threshold
13 Permitted (] Certified 0 Conditionally Certified © Registered Date Last Operated or Above Threshold: - w- -•
Farm Name: ........... County:
t
Owner Name:
Mailing Address:
Facility Contact: .............. _ ..__... _....___._ _.._ Title:
PhoneNo: ... _.......... _ _.._... _ _...
Phone No:
O[nsite Representative;.._._R 0 .._ �_.w_.........._ . _._._._._ ..W_.. Integrator:...!'�t.'.?
Certified Operator:. _l Q! �_ W....__.. at e r.a xl » Operator Certification Number:,-!!2
Location of Farm:
C%Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • & 44 Longitude • 6 «
Discharges & Stream Iin acts
1. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. 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 ® No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ® No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes [A No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: •-- .................... _ _....._....._...._. __ .._- - - ......... .. ..........__..__..... .....,._.._........ - , _....._....................
Freeboard (inches): 3s 00
12112103 Continued

Facility Number: fj — -f 7/
Date of Inspection
Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
S. Does any part of the waste management system other than waste structures require maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type GE &o #'" rca/c0. W.. / Sry+ - 1 I r. r. , u
❑ Yes IX No
❑ Yes [55 No
❑ Yes j No
❑ Yes ( No
❑ Yes 51 No
❑ Yes 0 No
0 Yes ❑ No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ® No
la. a) Does the facility lack adequate acreage for land application? ❑ Yes No
b) Does the facility need a wettable acre determination? ❑ Yes No
c) This facility is pended for a wettable acre determination? ❑ Yes No
15. Does the receiving crop need improvement? ❑ Yes No
16. Is there a lack of adequate waste application equipment? ❑ Yes No
Odor Issues
17, Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes [A 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 [9 No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes [)I 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 [X No
Air Quality representative immediately_

Facility Number: y.1 —tf'►I
Date of Inspection 16 i! I D
Required 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/ WLFP, checklists, design, traps, 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 ® No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
❑ 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 E No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0 Yes M No
NPDES Permitted Facilities
30. Is the facility covered under a NPDRS Permit? (If no, skip questions 31-35)
® Yes ❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes [0 No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes Z1 No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below_
Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
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