820464_INSPECTIONS_20171231

NORTH CAROLINA �
Department of Environmental Qua!

e
M Division of Water Resources
❑ Division of Soil and Water Conservation
❑ Other Agency
Facility Number- 820464 Facility Status:
Inpsection Type: Compliance Inspection
Reason for visit: Routine
Date of Visit: 09/22/2016 Entry Time: 01:00 pm
Farm Name: Farm 2046
Aclive Permit: AWS820464 ❑ Denied Access
Inactive Or Closed Date:
County: Sampson Region:
Exit Time: 2:00 pm Incident #
Owner Email:
Fayetteville
Owner: Murphy -Brown LLC Phone: [phone]
Mailing Address: PO Box 487 Warsaw NC 28398
Physical Address: $81 Gardenia Ln Clinton NC 28328
Facility Status: Compliant ❑ Not Compliant integrator: Murphy -Brown LLC
Location of Farm: Latitude: 35' 03' Longitude: 78' 14' 2T
On the north side of SR 1904 approx..8 miles west of its intersection with SR 1740.
Question Areas:
Dischrge & Stream Impacts
Records and Documents
Waste Col. Stor, & Treat Waste Applicalion
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:
Oa -site representative Mike Norris Phone:
Primary Inspector: Robert Marble Phone:
Inspector Signature: Date:
Secondary Inspector(s):
Inspection Summary:
page: 1

Permit: AWS820464 Owner - Facility : Murphy -Brown LLC Facility Number: 820464
Inspection Date: 09/22/16 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations Design Capacity Current promotions
Swine
Fff Swine - Feeder to Finish 10,496
Total Design Capacity: 10,496
Total SSLW: 1,416,960
Waste Structures
Disignated Observed
Type Identifier Closed Date Start Date Freeboard Freeboard
Lagoon 1 19.00 3fi.DD
page: 2

Permit: AWS820464 Owner - Facility : Murphy -Brown LLC Facility Number: 820464
Inspection Date: 09/22/16 Inppection 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?
❑
❑
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
❑ ■
❑
b_ Did discharge reach Waters of the State? (if yes, notify DWQ)
❑
❑
❑
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑
❑
❑
2. Is there evidence of a past discharge from any part of the operation?
❑
M ❑
❑
3. Were there any observable adverse impacts or potential adverse impacts to Waters of the
❑
0 ❑
❑
State other than from a discharge?
Waste Collection Storage & Treatment
Yes No Na Ne
4. Is storage capacity less than adequate?
❑
■ ❑
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (I.e./ large
❑
M ❑
❑
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a
❑
a ❑
❑
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
❑
■ ❑
❑
B. Do any of the structures lack adequate markers as required by the 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
❑
0 ❑
❑
maintenance or improvement?
Waste Application
Yes No Na Ne
1 D. Are there any required buffers, setbacks, or compliance alternatives that need
❑ 0 ❑ ❑
maintenance or improvement?
11. Is there evidence of incorrect application?
❑ 0 Cl ❑
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 manurelsludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
page: 3

Permit: AWS820464
Owner - Facility: Murphy -Brown LLC Facility Number: 820464
Inspection Date: 09/22l16
Inpsection Type: Compliance Inspection Reason for Visit: Routine
Waste Application
Yes No Na Ne
Crop Type 1
Corn, Wheat, Soybeans
Crop Type 2
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Norfolk loamy sand. 0 to 2%
slopes
Soil Type 2
Wagram loamy sand, o to
6% slopes
Soil Type 3
Marvyn loamy sand,
6 to
12% slopes
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?
❑ E 0
❑
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 ❑
❑
Records and Documents
Yes
No No 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?
❑
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?
❑
E []
[]
If yes, check the appropriate box below.
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
❑
Weather code?
❑
page: 4

Permit: AWS820464 Owner - Facility : Murphy -Brown LLC Facility Number: 820464
Inspection Rate: 09/22/16 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents
Yes No Na No
Rainfall?
❑
Stocking?
❑
Crop yields?
❑
120 Minute inspections?
❑
Monthly and T' 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 ❑
❑
(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
❑
0110
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?
❑
MCI
❑
27. Did the faciitty fail to secure a phosphorous loss assessment (PLAT) certification?
❑
0 ❑
❑
Other Issues
Yes No Na N*
28. Did the facility fail to properly dispose of dead animals within 24 hours andlor 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,
❑
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?
❑
0 ❑
❑
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
❑
M ❑
❑
CAWMP?
33. Did the ReviewerAnspector fait to discuss reviewfinspection with on -site representative?
❑
M ❑
❑
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
El Other Agency
Facility Number. 820464 Facility Status: Adive Permit: AWS820464 ❑ Denied Access
Inppection Type: Compliance Inspection Inactive Or Closed Date:
Reason for Visit: Routine County: Sampson Region: Fayetteville
Date of Visit: 11/0512015 EntryTime: 11:00 am Exit Time: 12:00 pm Incident #
Farm Name: Farm 2046 Owner Email:
Owner: Murphy -Brown LLC Phone: [phone]Boo
Mailing Address: PO Box 487 Warsaw NC 28398
Physical Address: 881 Gardenia Ln Clinton NC 28328
Facility Status: E Compliant ❑ Not Compliant Integrator: Murphy -Brown LLC
Location of Fans: Latitude: 35' 03'
On the north side of SR 1904 approx_ .8 miles west of its intersection with SR 1740.
Question Areas:
Dischrge 8 Stream Impacts
Records and Documents
Certified Operator: Bradley Devone Herring
Secondary OIC(s):
Waste Col, Stor, & Treat
Other Issues
Longitude: 78' 14' 29"
E Waste Application
Operator Certification Number: 26545
On -Site Representative(s): Name Title Phone
24 hour contact name Mike Norris Phone:
On -site representative Mike Norris Phone :
Primary Inspector:
Inspector Signature:
Secondary Inspector(s)-
Inspection Summary:
Robert Marble Phone:
Date:
page: 1

Permit: AWS820464 Owner - Faciiity : Murphy -Brown LLC Facility Number: 820464
Inspection Date: 11/05/15 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations
Design Capacity Current promotions
Swine
Swine Feeder to Finish 10,496
Total Design Capacity: 10,496
Total SSLW: 1.416,960
Waste Structures
Disignated Observed
Type Identifier Closed Date Start Date Freeboard Freeboard
Lagoon 1 19.00 37.00
page: 2

Permit: AWS820464 Owner - Facility : Murphy -Brown LLC Facility Number: 820464
inspection Date: 11/05/15 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Discharges & S"am Impacts
Yes No Na Ne
1 _ Is any discharge Observed From any part of the operation?
❑
■ ❑
❑
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)
❑
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?
❑
0 []
❑
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- N@_Ne
4. Is storage capacity less than adequate?
❑
❑
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (Le./ large
❑
M ❑
❑
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?
T. 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
[]
❑
❑
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 Ng_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: AWS820464 Owner - Facility : Murphy -Brown LLC Facility Number: 820464
Inspection Date: 11/05/15 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Waste Application
Yes No Na Ne
Crop Type 1
corn, Wheat, Soybeans
Crop Type 2
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Norfolk loamy sand, 0 to 2%
slopes
Soil Type 2
Wagram loamy sand, 6 to
6°% slopes
Soil Type 3
Mervyn loamy sand, 6 to
12°% slopes
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?
❑ E ❑ ❑
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?
❑ 0 ❑ ❑
18_ Is there a lack of properly operating waste application equipment?
❑ 0 ❑ ❑
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.
WU P?
❑
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: AWS820464 Owner - Facility : Murphy -Brown LLC Facility Number: 820464
Inspection Date: 11/05/15 Inppection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents
Yes
No Na Me
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?
❑
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?
❑
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:
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?
❑
❑
❑
Other Issues
Yes 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? It yes,
❑
■ ❑
❑
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-app[ication)
31, Do subsurface tile drains exist at the facility?
❑
0 ❑
❑
If yes, check the appropriate box below.
Application Field
❑
Lagoon f Storage Pond
❑
Other
❑
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or
❑
M ❑
❑
CAWMP?
33_ Did the Reviewer/Inspector fail to discuss reviewtinspection with on -site representative?
❑
❑
❑
34_ Does the facility require a follow-up visit by same agency?
❑
■ ❑
❑
page: 5

M Division of Water Resources
El Division of Soil and Water Conservation
El Other Agency
Facility Number.
820464 Facility Status:
Active Permit: AWS820464
Denied Access
Inpsection Type:
Compliance Inspection
Inactive Or Closed Date:
Reason for visit:
Routine
County: Sampson Region:
Fayetteville
Date of visit:
12/16/2014 Entry Time: 10:45 am
Exit Time; 11:30 am Incident #
Farm Name:
Farm 2046
Owner Email:
Owner
Murphy -Brown LLC
phone:
910-296-1800
Mailing Address: PO Box 487 Warsaw NC 28398
Physical Address: 881 Gardenia Ln Clinton NC 28328
Facility Status: Compliant ❑ Not Compliant Integrator: Murphy -Brown LLC
Location of Farm: Latitude: 35" 03'
On the north side of SR 1904 approx..8 miles west of its intersection with SR 1740.
Question Areas:
Dischrge & Stream Impacts
Records and Documents
Longitude: 78' 14' 29"
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: AWS820464 Owner - Facility : Murphy -Brawn LLC Facility Number: 820464
inspection Date: 12/16/14 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations Design Capacity Current promotions
Swine
0 Swine - Feeder to Finish 10,496
Total Design Capacity: 10,496
Total SSLW: 1,416.960
Waste Structure§
Disignated Observed
Type Identifier Closed Date Start Date Freeboard Freeboard
Lagoon 1 19.00 52.00
page: 2

Permit: AW582G464 Owner - Facility : Murphy -Brawn LLC Facility Number: 820464
Inspection Date: 12/16/14 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Discha es & Stream Impact's
Yes
No N. No
1. Is any discharge observed from any part of the operation?
❑
a ❑
❑
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)
❑
❑ ■
❑
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)
❑
110
❑
2. Is there evidence of a past discharge from any part of the operation?
❑
0 D
❑
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 NQ No 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
❑
0 ❑
❑
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a
❑
M ❑
❑
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
❑
No
❑
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
❑
❑
❑
maintenance or improvement?
Waste Application
Yes No Na No
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 manurelsludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
page: 3

Permit: AWS820464 Owner - Facility : Murphy -Brown LLC Facility Number: 820464
Inspection Date: 12/16/14 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Waste Application
Yes No Na Na
Crop Type 1
Com, Wheat, soybeans
Crop Type 2
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Norfolk loamy sand, b to 2%
slopes
Soil Type 2
Wagram loamy sand, 0 to
6% slopes
Soil Type 3
Mervyn loamy sand, 6 to
12% slopes
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?
❑
M ❑
❑
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?
❑
0 ❑
❑
18. is there a lack of properly operating waste application equipment?
❑
M ❑
❑
Records and Documents
Yes
No Na No
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑
0 ❑
❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑
0110
If yes, check the appropriate box below.
WUP?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Lease Agreements?
❑
Other?
❑
If Other, please specify
21_ Does record keeping need improvement?
❑
MCI
❑
If yes, check the appropriate box below.
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
❑
Weather code?
❑
page: 4

Permit: AWS820464 Owner - Facility : Murphy -Brown LLC Facility Number: 82D464
Inspection Date: 12/16/14 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents
Yes No Na No
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
❑
0
23, If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment
❑
❑
❑
(NPDES only)?
24, Did the facility fail to calibrate waste application equipment as required by the permit?
❑
❑
❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check the
❑
❑
❑
appropriate box(es) below:
Failure to complete annual sludge survey
❑
Failure to develop a POA for sludge levels
❑
Non -compliant sludge levels in any lagoon
❑
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑
0 ❑
❑
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
N ❑
❑
Otherlssues
Yes No Na Na
28. Did the facility fail to property dispose of dead animals within 24 hours and/or document
❑
M ❑
❑
and report mortality rates that exceed normal rates?
29. At the time of the inspection did the facility pose an odor or air quality concern? If yes,
❑
N ❑
❑
contact a regional Air Quality representative immediately.
30. Did the facility fait to notify regional DWQ of emergency situations as required by Permit?
❑
❑
❑
(i.e., discharge, freeboard problems, over -application)
31, Do subsurface tile drains exist at the facility?
❑
■ ❑
❑
If yes, check the appropriate box below.
Application Field
❑
Lagoon / Storage Pond
❑
Other
❑
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or
❑
0 ❑
❑
CAWM P?
33. Did the Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑
N ❑
❑
34. Does the facility require a follow-up visit by same agency?
❑
E ❑
❑
page: 5

0 Division of Water Resources
El Division of Soil and Water Conservation
❑ Other Agency
Facility Number: 820464 Facility Status: Active Permit: AWS820464 ❑ Denied Access
Inpseetion Type: Compliance Inspection Inactive Or Closed Date:
Reason for Visit: Routine County: Sampson Region: Fayetteville
Date of Visit: 12/11/2013 Entry Time: 09:30 am Exit Time: 10:30 am
Farm Name: Farm 2D45
Owner: Murphy -Brown LLC
Incident 9
Owner Email:
Phone: [phone]
Mailing Address: PO Box 487
Warsaw NC 28398
Physical Address: 881 Gardenia Ln
Clinton NC 28328
Facility Status: Compliant
❑ Not Compliant Integrator.
Murphy -Brown LLC
Location of Farm:
Latitude:
35' 03' Longitude: 78" 14' 29"
On the north side of SR 1904 approx..8 miles west of its intersection with SR 1740,
Question Areas:
Dischrge & Stream Impacts
Waste Col, Stor, & Treat
Waste Application
Records and Documents
Other Issues
Certified Operator: James Blake Moore Operator Certification Number: 26555
Secondary OIC(s):
On -Site Representative(s): Name Title Phone
24 tour contact name Mike Norris Phone:
On -site representative Mike Norris Phone
Primary Inspector: Robert Marble
Inspector Signature:
Secondary Inspector(s):
Inspection Summary:
Phone:
Date:
page: 1

Permit: AWS820464 Owner - Facility : Murphy -Brown LLC Facility Number: 820464
Inspection Date: 12/11/13 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations Design Capacity Current promotions
Swine
Swine - Feeder to Finish
Total Design Capacity:
Total SSLW:
Waste Structures
Disignated Observed
Type Identifier Closed Data Start Date Freeboard Freeboard
Lagoon t 19_iM
page: 2

Permit AWS82€7464 Owner - Facility _ Murphy -Brown LLC Facility Number 820464
Inspection Date 12/11/13 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Discharges & Stream Impacts
Yes
No Na No
i. 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)
❑
❑ 0
❑
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
❑
0 ❑
❑
State other than from a discharge?
Waste Collection Storage & Treatment
Yes No Na Ne
4. Is storage capacity less than adequate?
❑
M ❑
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (I.e./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
❑
M ❑
❑
to rooted 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
❑ ■ ❑ ❑
maintenance or improvement?
11. Is there evidence of incorrect application?
❑ E ❑ ❑
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
❑
PAN?
❑
Is PAN > 10%l10 Ibs,7
❑
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 AWS820464 Owner - Facility : Murphy -Brown LLC Facility Number: 820464
Inspection Date: 12/1 V13 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Waste Application
Yea No Na No
Crop Type 1
Com, Wheat, Soybeans
Crop Type 2
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Norfolk loamy sand, 0 to 2%
slopes
Soil Type 2
Wagram loamy sand, 0 to
6% slopes
Soil Type 3
NMarvyn loamy sand, 6 to
12 % slopes
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?
❑ M ❑ ❑
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?
❑ M ❑ ❑
18_ Is there a lack of properly operating waste application equipment?
❑ M ❑ ❑
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
Willi
❑
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: AWS820464 Owner - Facility : Murphy -Brown LLC Facility Number: 820464
Inspection Date: 12/11/13 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents
Yes
No Na Na
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?
❑
■ ❑
❑
23. If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment
❑
00
❑
(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 dale 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?
❑
E ❑
❑
Other Issues
Yes No No Me
28. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑
❑
❑
and report mortality rates that exceed normal rates?
29. At the time of the inspection did the facility pose an odor or air quality concern? If yes,
❑
0 ❑
0
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?
❑
0 ❑
❑
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
❑
0 ❑
❑
CAWM P?
33. Did the ReviewerAnspector fail to discuss reviewfinspection with on -site representative?
❑
M ❑
❑
34_ Does the facility require a follow-up visit by same agency?
❑
■ ❑
❑
page: 5

Type of Visit: 40 Compliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: 49 Routine O Complaint Q Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: Arrival Time: O;pp Departure Time: County: �
f Od Region: 0
Farm Name: 26 6 3 Owner Email:
Owner Name: l "iY1�1� Phone:
Mailing Address:
Physical Address:
Facility Contact: t M d Q-{y� Title:
Onsite Representative: t'l
Certified Operator: j9/q �Ck Aj_e
Back-up Operator:
Phone:
Integrator: lrl
Certification Number:
Certification Number;
Location of Farm: Latitude: Longitude:
� Desi
Current �
Design
Currents
©eSigu Current
Swore � . rri � Ca aei
P tY
Po Wet'Poult
p•. rye
Ca act
p ty
p. Cattle Cgpaeity Pop.
P,o�'
an to Finish
La er
DairyCow
an to Feeder
Non -La er
DairyCalf
-er
to Finish
A
-
p
Design
- _`
Current-_
DairyHeifer
ow to Wean
D Cow
ow to Feeder
tIBoajrs
D . P,oult
Ca aci
l'o ,.,.. l
Non -Dairy
Beef Stocker
ow to Finish
Layers
Non -Layers
Beef Feeder
Pullets
Beef Brood Cow
:.
Turkeys
Other aa. " oil
Turke Poults
Other
Other
Discharges and 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 IM 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 j❑� 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 inspection: '?
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. I f yes, is waste level into the structural freeboard?
❑ Yes
0 No
NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Stru
e 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
ep No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
1P
❑ 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 or improvement?
1. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ['Fla -'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 Acce table Crop indow ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): i _�;' 1.. 5,
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components ofthe CAWMP readily available? Ifyes, check
the appropriate box.
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
[] Yes
[ ?No
❑ NA
❑ NE
❑ Yes
t!F�4o
❑ NA
❑ NE.
❑ Yes
P No
❑ NA
❑ NE
[] Yes
P No
❑ NA
❑ NE
El Yes
�No
❑NA
❑NE
❑ WUP ❑Checklists ❑ Design [] Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below_ ❑ Yes 0 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge`? ❑ Yes [ No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? []Yes �] No
❑ NA ❑ NE
❑ Weather Code
[:]Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - 46 Date of Inspection: `7 Z7 7—
�4. 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. 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?
27. Did the facility fail to secure a phosphorus loss assessments (FLAT) certification?
Other Issues
28. Did the facility fail to property dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal'?
24. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes I No
[:]Yes ❑ No
❑ Yes No
❑ Yes �No
❑ NA ❑ NE
•P NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes T No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes M No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes EpNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes M No [] NA ❑ NE
Comments (refer to question!#.) Ezplatn any YES answers and/or: any additional'recommendations or;any-ntheT�c'omments.
Use drawings bf facility to better._explam sitaations.(use additional'J aN ; s necessary) k
epen,-4� re_vi ewle�
S-k � �31 717711 'Z i
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: 17(17ZL
21412011

Type of Visit: 4P Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 10 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: O 2t Arrival Time: Departure Time: County-522!�_%&j Region: �c3
Farm Name: & q 0 Owner Email:
Owner Name: -hoAOnj44 Phone:
.T
Mailing Address:
Physical Address-
'
Facility Contact: 141te Ass Title: Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current Design Current �' Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pop.
{
Wean to Finish
airy Cow
Wean to Feeder
Non -Layer
airy Calf
Feeder to Finish
('j
�'
Design CurrentDry
D"`P,oult ` ,x Ga .acity P,o ,
Dai Heifer
Farrow to Wean
Farrow to Feeder
Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts -
Boars
Other
Non -Layers
Beef Feeder
Pullets
Beef Brood Cow
Turke s
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a, Was the conveyance than -made?
b, Did the discharge reach waters of the State? (If yes, notify DWQ)
0 Yes P No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes 0 No
NA ❑ NE
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 5 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

f*4c_ili Dumber: jDate of Inspection: O ZI
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes rL(j%A No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No FONA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): l�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes JE�jNo ❑ 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)
4. Does any part of the waste management system other than the waste structures require ❑ Yes allo ❑ 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? t9
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.
❑ PAN ❑ PAN 7 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): L►orvx, , i"Goon S.
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Re uired Records & Documents
14. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box_
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes No
❑ Yes No
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [�NNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Faeiili umber: - Date of Ins ection: /o /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes j� No ❑ NA [] NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Otber 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.
T�
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)
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:
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
Vg No ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No ❑ NA
P
❑ NE
t}h-e'r comments.
refer toliuequestion Ex:pl:a._in an YES answers and/or and/or angadditional recommendations or a=n
_..Comments
Use drawings of faciLtytob�etter xlatnsituattons (use additional pages as necessary)•
�o"
T-e 7 % v O r 1'
,5,-k
Reviewer/Inspector Name:
Phone:
Reviewer/Inspector Signature:
Date:
Page 3 of 3
21412011

I
Type of Visit *Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine O Complaint Q Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: ( O A,rri,-•al Time: Z,'� Departure Time: County: _S4 � Region: _
Farm Name: 2 T 20�0 ___ Owner Email:
Owner Name: + �l� w>��- Phone:
Mailing Address:
Physical Address:
Facility Contact: L4 1t Title:
N
Onsite Representative:
Certified Operator: a / - ►Cry .
Back-up Operator,
Location of Farm:
Phone`` No:
Integrator:17r� _.
Operator Certification Number: S3
Back-up Certification Number:
Latitude: Q n [--] ' ❑ « Longitude: a o = ' = "
Swine
Design Current Design Current Design Current
Capacity Population tVet Ponitry Capacity Popnlatian Cattle Capacity Population
❑ Wean to Finish
IEJ Layer
❑ Dairy Cow
❑ Wean to Feeder
10 Non -Layer
❑ Daia Calf
Weeder to Finish
110 IN4
1D
❑ Dairy Heifer
Farrow to Wean
❑ Farrow to Feeder
Dry Poultry ❑ Dry Cow
El Non -Dairy
❑Layers
❑ Beef Stocker
❑ Non -Layers ❑ Beef Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Pullets
El Beef Brood Cowl
❑ Turkeys
❑ Turkey Poults
❑ Other
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 matt -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 [ANo ❑ NA ❑ NE
❑ Yes
❑ No
NA
❑ NE
ElYes
ElNo
NA
❑ NE
NA
ElNE
❑ Yes
❑ No
❑ Yes
No
NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page 1 of 3 11/18104 Continued

'acility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'?
❑ Yes
VNo
❑ NA
El NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
q�NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 33
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
NRNo
tr
[INA
ElNE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
�d 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 No ❑ NA [I 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 allo ❑ NA ❑ NE
maintenance or improvement? //
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes Wo El NA El NE
maintenanceli mprovement?
11. Is there evidence of incorrect application'? If yes, check the appropriate box below. ❑ Yes rNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate ManurclSludge into Bare Soil
❑ Outside of Acceptablerop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) W
13. Soil type(s) ► cL l /V0 LX � h
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
9No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
P(No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
(9 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
E;(No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
RNo
❑ NA
❑ NE
_Comments (refer to question #) Explain any YES answers and/or any recommendations or any other comments.-,-`-
lase di swings of facility to better eplain situations. (use additional pages as necessary): T
Reviewer/Inspector Name I Phone: S-S$fXJ
Reviewer/inspector Signature: 5�Date: IIA&O
12128104 Continued

Facility Number:KAq Date of Inspection
Required Records & Documents
19_ Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �'No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA W MP readily available? If yes, check Cl Yes No ❑ NA ❑ NE
the appropriate box. ❑ W Up ❑ Checklists ❑ Design ElMaps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes T No ElNA ❑ NE
ElWaste Application ElWeekly Freeboard ❑ Waste Analysis ElSoil Analysis ElWaste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No [).NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
-Ep No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
f�No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
fjjNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
T ►No
❑ NA
❑ NE
Other Issues
rr
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�zNo
❑ NA
❑ NE
Page 3 of 3 12128104

Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit ORoutine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of visit: Arrival Time: Departure Time: a '[x} County: S�-CQd Region:
Farm Name; Ewm ;20 _ Owner Email:
Owner Name h CC( Phone:
Mailing Address:
Physical Address:
Facility Contact: "' `_6C'y y Title: Phone No:
Onsite Representative: Integrator:
it,,r
Certified Operator: 5 A"Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = o = ` [:] Longitude: = ° 0 ' = u
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑Layer
❑ Dairy Cow
Wean to Feeder
❑Nen-layer
��
❑ Dairy Calf
Feeder to Finish
❑ Farrow to Wean
in
❑ Dairy Heifer
Dry Pottitry ❑ Dry Cow
❑ Layers ElNon-Dairy
❑ Beef Stocker
❑ Non -Layers ❑Beef Feeder
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
❑ Beef Brood Co
Number of Structures:
❑ Boars
Other
❑ Other
Dischars=es & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [PNo ❑ NA ❑ NE
❑ Yes
❑ No
[j9 NA
❑ NE
❑ Yes
❑ No
OiNA
❑ NE
[�)NA
❑ NE
❑ Yes
❑ No
❑ Yes
M No
❑ NA
❑ NE
❑ Yes
EPNo
❑ NA
❑ NE
12128104 Continued

• Facility Number,
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 03 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No WNA ❑ NE
Stru ture I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
[] Yes
&No
❑ NA
❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
5 No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
10 No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
,2 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
�bNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
N No
❑ NA
❑ NE
maintenance/improvement?
11
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Wo
❑ 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 i
12. Crop type(s)
13. Soil type(s)
❑ NA ❑ NE
14. Do the receiving crops differ from those designated in the CAWMP?r
❑ Yes
[ANo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
gMNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
F 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
EONo
❑ NA
❑ NE
Comments (refer to question #) Explain any YES answers and/or any recommendations ae any other'comments.
Use drawings of facility to better explain situations. (use additional pages"as haieisary)�"�
ReviewerAnspector Name - , -` Phone: y�D-y33�33�
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ONo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check 0 Yes y
No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [PNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No [:1 NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No P NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes -P No
❑ NA
❑ NE
25_ Did the facility fail to conduct a sludge survey as required by the permit?
O 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
U1 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
IR 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
P No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[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
4 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
W No
❑ NA
❑ NE
12178104

J
Type of Visit 10 Compliance Inspection U Operation Review U Structure Evaluation Q Technical Assistance
Reason for Visit * Routine d Complaint O Fallow up O Refers[ O Emergency Q Other ❑Denied Access
Date of Visit: l Arrival Time: Departure Time: County: Region: )CAQ
Farm Name: `0791v� Owner Email:
Owner Name: f bt c� LL-.- Phone:
Mailing Address:
Physical Address:
Facility Contact: �'�^ Title:
u
Onsite Representative:
Certified Operator: J2.rnt?.5 0, mcorC
Back-up Operator:
Phone No:
A�
Integrator:. ! "u u I LLC—
Operator Certification Number:
Back-up Certification Number:
Location of Farm: latitude: o Longitude: = o
Design Current
Resign @urrent
Design Current
Swine Capacity Population
Wet Poultry catty
Cattle Capacity Population
❑ Wean to Finish
ypop�lation
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La er
❑ Dairy Calf
Feeder to Finish
e` _
❑ Dairy Heifer
El Farrow to Wean
Dry Poultry'•
❑ Dry Cow
❑ Farrow to Feeder
Layers
El La
❑ Non -Dairy
❑ Farrow to Finish
❑Non-La ers
ElBeef
Gilts
❑ Beef Feeder
PE01Boars
❑Pullets
❑Beef Brood Co
other �.:
❑ Other
Kumber of Structures:
,= ..
❑ turkeys
❑ Turkey Points
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
§No
El NA
❑ NE
Discharge originated at: ❑ Structure [I Application Field [I Other
a. Was the conveyance man-made?
❑ Yes
❑ No
P NA
[I NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
RNA
El NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
(�NA
El NE
2. Is there evidence of a past discharge from any part of the operation'?
El Yes
�lo
El NA
El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
Wo
❑ NA
ElNE
other than from a discharge?
Page 1 of 3
12128104
Continued

facility Number:Mc Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
I—ZNo
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
P�J4A ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
a
Observed Freeboard (in): J l
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
PNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
4No
❑ 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
C..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
MNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
110 No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below.
❑ Yes
PNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/SIudge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
� , �' Cif Ctlh n r�ru;-fs f
12. Crop type(s) rn , W S e SM h
13. Soil type(s) i/[a-ft., 4 v, —
14.
v
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
LpNo
❑ 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
f No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
T No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
Fallo
El NA
El NE N
�.,
Comments (refero questiot>< �Eapiarna nyYEnswers andlor anyzrecommen�atiorts ar any other comments.
Use drawings of facrl ty to better explain sitirarA ifj i agdihonal pages asinec scary):
�..._
�VIREMEWMERa w: .
A►
Reviewer/Inspector Name r Phone: J�3
Reviewer/Inspector Signature: VIL Date: I'
D - 7 _'r 2 vynA//a.4 I/'n.. finr.nd

' -Facility Number: Date of Inspection
Required Records & Documents
19_ Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes NP No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes t�No ❑ NA ❑ NE
the approprrate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps
p ❑ ether
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes `3 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and i" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
19 No
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
6 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
49 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
t9 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
2No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
,ZNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
b-,
I� No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ASNo
❑ 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
0 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
ANo
❑ NA
❑ NE
33_
Does facility require a follow-up visit by same agency?
❑ Yes
,qNo
❑ NA
❑ NE
Additional Cointnetits.audlor Drawrngs:
Page 3 of 3 12128104
Page 3 of 3 12128104

40 Division of Water Quality
I HEWFacility Number a 0 Division of Soil and Water Conservation
0 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 i D`� Arrival Time: Departure Time: County:
Farm Name: A0 4l7 7 Owner Email:
Owner Name: MU/Ore6 V (k)Lj l^ Phone: _
Mailing Address:
Physical Address:
Facility Contact: l9f M ger Title:
tl
Onsite Representative:
Certified Operator: g'4k?, 0OOr2
Back-up Operator:
Location of Farm:
Swine
Other
❑ Other
Latitude:
n°
Region:
�t^ Phone No:
Integrator: MI,(n''0 CNl71ah �y
Operator Certification Number: o 65
Back-up Certification Number:
LLongitude:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
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 Populatioi
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ 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 [PNo ❑ NA ❑ NE
❑ Yes ❑ No ® NA ❑ NE
❑ Yes ❑ No ` NA ❑ NE
❑ Yes ❑ No T, NA ❑ NE
❑ Yes [ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
12128104 Continued

Facility -Number
Date of Inspection 3i n
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
8 NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
r�
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes tj 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 F1 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 IMNo ❑ 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 15 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need 0 yes P No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes g9No ❑ NA ❑ NE
❑ Excessive Ponding ❑ hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
��
12. Crop type(s) C err! W kkat . 3en-., S � � "�-� tae� Jt `^ ' �9r • _
13. Soil type(s) M0. &)D$, 11'Gt�
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �D No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ yes 10 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[3 Yes IC] 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 V 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 r Phone: 9 D "3-3 be
Reviewer/Inspector Signature: Date: - ?1 p
12128104 - Continued

r • L
Facility Number:' Date of Inspection I
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes F No [IN El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes %No ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keepingneed improvement? if yes, check the appropriate box below. ❑ Yes No DNA ❑ NE
p
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
1J No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit'?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Z) 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 CA WMP?
❑ Yes
91 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[l Yes
A 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
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
R9 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
M No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

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: Arrival Time: �i,�} .4 -- Departure Time: County: ';"4;0h Region:
Farm Name: 6 � �-P� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: ff-Y- Title:
c�
Onsite Representative:
Certified Operator:
Back-up Operator:
— Phone No:
j
Integrator: r_' `U.'VA4, 6m,")o
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: E] e ❑ ' E] N Longitude: EJ ° ❑ ' ED L
Design Current ``=r<Design Current Design Ctacrent
Swine Capacity Population Wet Ponitryc ;Capacity Population Cattle Capacity Population
It y
❑ Wean to Finish ❑ La er ❑ Da' Cow
❑ Wean to Feeder ❑Non -La c:r ❑ Daja Calf
Feeder to Finish ".:_ ❑ Dairy Heifer
❑ Farrow to Wean Dry Poultry -� El Da Cow
• Farrow to Feeder El Non -Dairy
ElFarrow to Finish ❑ La ers
❑Beef Stocker
PO
Gilts ElNon-La ersEl Pullets Beef Feeder
t� Boars ❑ Turke s ElBeef Brood Cowl
Other
❑ Turke Poults t"
❑ Other ❑Other, Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
EN No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
® NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of 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
® No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

f I
Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
VI No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
1p No
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Q3 No
❑ NA ❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
IP 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
� No
[I NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
El NA [I NE
maintenance or improvement?
PONo
!!
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
E] Yes
f 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 l0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[5j No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
P No
❑ NA
❑ NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
Qa 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
PS No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any btber;cbmments ^ p=;�,;_. ,
Use drawings of facility to better explain situations. (use additional pages as necessary): a
Reviewer/Inspector Name F_ Phone: %/a qy;
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 JU No ❑ NA ❑ NE
20. Does the facility fail to have ail components of the CA WMP readily available? If yes, check ❑ Yes [9 No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design [I Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stacking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[W 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
P] NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes]
No
[INA
I --]NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
IV No
❑ NA
❑ NE
Additional Comments -and/or Drawings:
Page 3 of 3 12128104

Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Q Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: D Arrival Time: Departure Time: County: Region: F-R-0
Farm Name.• _ w�'�^ ED __ Owner Email:
Owner Name: zcP32=!4 Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: C�.,[=-A C rz_�r, {�
Certified Operator: , `a el. ' V lrlr_ —
Back-up Operator:
Phone No:
Integrator: �t.L�•rQ�- _
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: El o u Longitude: =
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
I�❑ La er
JE3 Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
Design Current
Capacity Population,:
❑ Dai Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ 2a Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
i
Number of Structures:FRI
i
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 i�[No ❑ NA ❑ NE
❑ Yes
❑ No
[ NA
❑ NE
❑ Yes
❑ No
® NA
❑ NE
UrNA
❑ NE
❑ Yes
❑ No
❑ Yes
[No
❑ NA
❑ NE
❑ Yes
PrNo
❑ NA
❑ NE
12128104 Condnued

Facility Number: — Date of Inspection 0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ,QNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes §9 No 6NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: rr
Spillway?: t/l G
Designed Freeboard (in):
Observed Freeboard (in): ~!O
5. Are there any immediate threats to the integrity of any of the structures observed?
0 Yes
o
El NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
r
6. Are there stmctures on -site which are not properly addressed and/or managed
❑ Yes
M 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
IN No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
L *o
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
,®No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
P No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifi❑ Application Outside of Area
k�e
12. Crop type(s) _ -` Y �S,�. Gu''tYE - �tf,�� `� �� _Ul Gi act Eti �t =
y S ;
4C0
13. Soil type(s) M c - h 1, r,P4 sm_4/ys 1
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
O No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination: ❑ Yes
f].No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
E�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
K No
❑ NA
❑ NE
Reviewer/Inspector Name I
Reviewer/Inspector Signature:
yK
�``�f/G)-
. n. '.
Phone: (p a
Date: �e)
12128104 Continued

Facility plumber: �� — fir, Date of Inspection 0
Reguired Records _& Documents
19, Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ldNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Olo ❑ NA ❑ NE
the appropiiate box, ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21 _ Does record keeping need improvement? If yes, check the appropriate box below. JK Yes ❑ No ❑ NA ❑ NE
Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 4 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes allo ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
R No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit'?
❑ Yes
21 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
P§ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) Certification?
❑ Yes
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
KNo
❑ 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
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems. over application)
32.
Did Reviewer/Inspector fail to discuss reviewfinspection with an on -site representative?
❑ Yes
,® No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
RNo
❑ NA
❑ NE
A[iditeoiial Comments aadlor Drswingsr
,M s��kp- " Z C /re c� S
-W 0ry4 - 0 r-rc -:Fe- 1•� !&+CZZJ 0-F Spy b t✓�� ��c� v , c� � � 4v
WLyp . .:-24 wG
10 a-ss 1 b f__ -
12128104

'Type of Visit 0 Compliance inspection O Operation Review O Lagoon Evaluation f
Reason for Visit A Routine O Complaint p Follow up O Emergency Notification O Other ❑ Denied Access
liarility Number IV
ate of Visit: 6 �T Time: 1.2 : D
Q Not Operational Q Below Threshold
Permitted 0 Certified [3Conditionally Certified D Registered Date Last Operated or Above Threshold
Farm Name: ....teaz%--- - — ---- »». - - County:. �. Sc ^.� �—.- . .. F L.o
Owner Name: _.� ..__ __........ _.. ...___.-_ ._ . .._... Phone No: _._...._ . _ . __._ —... _.. _ ...... .
Mailing Address:
Facility Contact: _..-.........//fJ................................... ...... ...-.... ..... Title:... ....... ... --- -_ _ .......... Phone No:
Onsite Representative:.....! -----. r� ._--..._ ......_.-.----- ------- Integrator: .. %M ... ��r�
Certified Operator:.__ �,��,{- ---. Operator Certification
Location of Farm:
[0 Swine ❑ Poultry [] Cattle ❑ Horse Latitude • 4 " Longitude • 4 64
Discharges & Stream Impac
1. Is any discharge observed from any part of the operation? ❑ Yes [V 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? /t
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) j] Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes [A No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes (0 No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 35 No
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ............ ......... _............ .................. ........ �...... ...._.............. _._....... ...... ..................... ......... ....... .................
Freeboard (inches): -3
12112103 CondAned

Facility Number: 8,� — yey Date of Inspection G l7 O
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 [j 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 maintenancelimprovement? Yes ❑ No
S. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level [Yes No
elevation markings?
Waste Analication
10. Are there any buffers that need maintenance/improvement?
❑ Yes
5No
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
[3No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type B«ws�rd�G �'�.o.� ! Sisse// ctric7D�i
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
j No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
MNo
b) Does the facility need a wettable acre determination?
❑ Yes
MNo
c) This facility is pended for a wettable acre determination?
❑ Yes
IP No
15. Does the receiving crop need improvement?
❑ Yes
[� No
16. Is there a lack of adequate waste application equipment?
❑ Yes
PNo
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
No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
J,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
WNo
Air Quality representative immediately"
of
Field Copy ❑ Final Notes �
7- 44fop.0
}ttoQ. �aa2 6ec+. 1lJ;rPos-d2. of or. +'�►c ,���c� 6Q,. _ bci.►.��Q t�.c
141000% . b10 P'} G o +c Ck rr' fsrr iy C•...Q �0 1'�nt p14dL�. `1r1Qv cgi
ytiy`..4.rt. VoJC c+ r,4cLti-1 c��lE�rscG�i�rlpv+wac�'FC� �a.�p0.C� e_t"JJQ
Reviewer/Inspector Name rr 1 r . r
Reviewer/Inspector Signature Date
I2112103 [/ Continued

• Facility Number: — efLt{ Date of Inspection /7
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
11 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
Un No
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[4 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
It No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
(Z No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
❑ Yes
1P 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}
No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
[4 No
NPDES Permitttsl Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes [ 1No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below_ ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

i
Site Requires Immediate Attention:
Facility No. v
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: �'J , 1995
Farm Name/Owner: G
Mailing Address: P. d. 1
Time: / �-- 3 ' —
G .2k5 9f1
County:
Integrator: Carroll Focds Phone:
On Site Representative: pnn T,Cae Phone:
Physical Address/Location: A/ arm 'F-C/ /f /f
Type of Operation: Swine Poultry Cattle
Design Capacity: Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon have sufficie
(approximately 1 Foot + 7 inches) re'�1s or No
Was any seepage observed from the agoon(s)?
Is adequate land available for spray? e or No
Crop(s) being utilized:
nt freeboard of 1 Foot + 25 year 24 hour storm event
Ac Freeboard: _Ft. Inches
Yes or &Was any erosion observed? Yes o�R
Is,TeM r dequate? nes or No
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings) � or No
100 Feet from Wells? or o
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or C
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or�*
Is animal waste discharged into water of ttostate by man-made ditch, flushing system, or other
similar man-made devices? Yes or If Yes, Please Explain.
Does the facility maintain adequate waste management recoor s (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? teor No
Additional Comments:
- D - 1 'J04/e's
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

r
JUL 14 "35 11;4EnM
NORTH CAROLMA DSPl,R7XE--C OF INVMO IMM, EMLTE & NATURAL RPSOURCFS
DIVISION OF WTMOMV=AL ii]NAG2MNT
Fayetteville Regional Office
Animal Operation Complia.ace Inspection Fora
All, questions answered negatively will be discussed in sufficient detail in
the Comments Section to enable the deemed Permittee to perform the appropriate
corrections:
SECTION I
imal O eraticn
Horses, cattle,- ie pault_-y, or sheep
SECTION II
1. Does the number and type of animal meet or exceed
the (.0217) criteria? [Cattle (100 head),
horses (75), swine (250), sheep (1,000), and
poultry (30,000 birds With liquid waste
system)] •
2. Does this facility meet criteria for
Animal Operation REGISTRATION?
3. Are animals confined fed or maintained
in this facility for a 12-month period?
4. Does this facility have a CRitT�IED ANIlrtar
WAS GZXEMT EL .
S. Does this facility maintain waste management
records (Voivaes of manure, land applied,
spray irrigated on specific acreage With
specific cover crop)?
5. Does this facility meet the SCS minimum
setback criteria for neighboring houses,
wells, etc?
k�Ai7 I ffk• .1rl:,#

'-L -- -- -- 3UL 14
zSE�i'ZON ISI
Y W C:ObS�Ir : S
Field Site Mz-jacement
i , Is animal waste stack -ailed or lagoon
construction within 10O ft- of a USG5
Hap Blue Line Stream?
2. Is ar_imal waste land applied or spray
irrigated within 25 ft, of a VSGS Map
Blue? Lime Stream?
3. Does this facility have adequate acreage
an which to apply the waste?
4. Does the land application'site have a
cover crop in accordance with the
CPRTIFICATION PLAN?
5. Is animal waste discharged into waters of
the state by man-made ditch, flushing system,
or other similar man-made devices?
6. Does the animal waste management at this
fart. adhere to Best Management Practices
(B►T) of the approved CERTIPI
7. Does animal waste lagoon have sufficient
freeboard? Mow much? (Approximately
E. Is the general condition of this CAFO facility,
including management and operation,
satisfactory?
SECTION IV
Co*..-ne is