410020_INSPECTIONS_20171231

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U
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c
3. Article Addressed to:
4a. Article Number
MR LAWRENCE CLEMMER
P 536 316 593
c
a
7059 HOLTS STORE RD
4b. Service Type
•
BURLINGTON NC 27215
❑ Registered JCertifled
=
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a
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PS Form 3811, December 1994 Domestic Return

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UNITED STATES POSTAL SERVI� 1 } R IA ~—�'-�---� -POStElge.&. ees-
`���ti �1.Postage &.Fees.Paid
• Print your' ai .As, and ZIP CodB'irrthis fioX
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NC DEHNR
WATER QUALITY SECTION P. �-
585 WAUGHTOWN STREET
WINSTON SALEM NC 271„07�►' ON
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State of North Caroline
Department of Environment,
Health and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
A. Preston Howard, Jr., P.E., Director
Lawrence Clemmer
Beaver -Rill Farms
7059 Holtstore Rd.
Burlington NC 27215
Dear Lawrence Clemmer:
A • •
AO
OL
[D F:4
May 30, 1997 RECEIVED
N.C. Dept. of EHNR
JU N 0 3 1997
Winston-Salem
Regior-ial office
Subject: Removal of Registration
Facility Number 41-20
Guilford County
This is to acknowledge receipt of your request that your facility no longer be registered as an animal waste
management system per the terms of 15A NCAC 2H .0217. The information you provided us indicated that your operation's
animal population does not exceed the number set fortli by 15A NCAC 2H .0217, and therefore does not require registration
for a certified animal waste management plan.
Under 15A NCAC 2H .0217, your facility is deemed permitted if waste is properly managed and does not reach the
surface waters of the state. Any system determined to have an adverse impact on water quality may be required to obtain a
waste management plan or an individual permit. You are reminded that a discharge of wastes to the surface waters of the state
will subject you to a civil penalty up to $10,000 per day.
Should you decide to increase the number of animals housed at your facility beyond the threshold limits listed below,
you will be required to obtain a certified animal waste management plan prior to stocking animals to that level. Threshold
number's of animals which require certified animal waste management plans are as follows:
Swine
250
Confined Cattle
too
Horses
75
Sheep
1,000
Poultry with a liquid wastes stem
30,000
If you have questions regarding this letter or the status of your operation please call Sue Homewood of our staff at
[phone] ext 502.
'�-(X A. Preston Howard, Jr., P,F.
cc: &N ins -to ti_SaI nt "'ater t I i FT Rionul Oftic�
Guilford Soil and Watcr Conservation District
Facility File
P.O. Box 29535. Raleigh, North Carolina 27626-0535 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

State of North Carolina
Department of Environment,
Health and Natural Resources
James B, Hunt, Jr., Governor
Jonathan B. Howes, Secretary
Steve W. Tedder, Chairman
December 5, 1996
41 0 WA
[DEHNR
Lawrence Clemmer
RECEIVED
Beaver -Rill Farms
7059 Holtstore Rd.
N.C. Dept. C i EI NR
Burlington NC 27215
DEC 12 1998
Subject: Operator In Charge Designation
Facility: Beaver -Rill Farms
s e m
Facility M #: 41-20
Guilford County
Dear Mr. Clemmer:
Senate Bill 1217, An Act to Implement Recommendations of the Blue Ribbon Study Commission on
Agricultural Waste, was enacted by the North Carolina General Assembly on June 21, 1996. This bill
requires that a certified operator be designated as the Operator in Charge by January 1, 1997, for each animal
waste management system that serves 250 or more swine, 100 or more confined cattle, 75 or more horses,
1,000 or more sheep, or 30,000 or more confined poultry with a liquid animal waste management system. Our
records indicate that your facility is registered with the Division of Water Quality and meets the requirements
for designating an OIC.
A training and certification program is not yet available for animal waste management systems involving
cattle, horses, sheep, or poultry. Owners and operators of these systems will be issued temporary animal waste
management certificates by the Water Pollution Control System Operators Certification Commission
(WPCSOCC). The temporary certificates will expire December 31, 1997, and will not be renewed. To obtain
a permanent certification, you will be required to complete ten hours of training and pass an examination by
December 31, 1997. A training and certification program for operators of animal waste management systems
involving cattle, sheep, horses, and poultry is now being developed and should be available by the spring of
1997. The type of training and certification required for the operator of each system will be based on the nature
of the wastes to be treated and the treatment process(es) primarily used to treat the animal waste.
As the owner of an animal operation with an animal waste management system, you must designate an
Operator in Charge and must submit the enclosed designation form to the WPCSOCC. If you do not intend to
operate your animal waste management system yourself, you must designate an employee or engage a contract
operator to be the Operator in Charge. The person designated as the Operator in Charge, whether yourself or
another person, must complete the enclosed application form for temporary certification as an animal waste
management system operator. Both the designation form and the application form must be completed and
returned by December 31, 1996.
If you have questions about the new requirements for animal waste management system operators, please call
Beth Buffington or Barry Huneycutt at 91gn33-0026.
Sincerely,
/qet,., au
FOR Steve W. Tedder
Enclosures
cc: Winston Salem Regional Office
Water Quality Files
Water Pollution Control System W �� Voice 919-733-0026 FAX [phone]
Operators Certification Commission NVfrcAn Equal Opportunity/Affirmative Action Employer
P.O. Box 29535 Raleigh, NC 27626-0535 50% recycled/10% post -consumer paper

b Y�
State of North Caro fi'f 0
Department of Environment,
Health and Natural Resources
Winston-Salem Regional Office
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
�EHNR
DIVISION OF ENVIRONMENTAL MANAGEMENT
May 10, 1996
Mr. Lawrence Clemmer
7059 Holts Store Rd.
Burlington, NC 27215
SUBJECT: Follow Up Farm Inspection
Clemmer Dairy Farm
Guilford County
Dear Mr. Clemmer:
Due to recent concerns about agricultural impacts to waters of the State,
the Division of Environmental Management conducted inspections of all registered
farming operations involving livestock. Mr. Ron Linville of this office in
conjunction with Mr. John Andrews, District NRCS Conservationist visited your
animal operation on April 16, 1996.
Observations at your facility have been categorized as follows:
Category I. NOTICE OF VIOLATION
A wastewater lagoon at your facility has overflowed.
Adequate freeboard (minimum of 1911) is not being maintained in the
lagoon.
A pipe, ditch or other conveyance can contribute to waste being
discharged from the animal operation.
Operational and Maintenance concerns exist which are likely to cause
animal waste runoff in a manner that is detrimental to water
quality.
Category II, NOTICE OF CONCERN
Parlor wash, calf feeding or other activities could contribute
negative impacts to water quality.
Loafing areas have the potential to release waste intermixed with
rainfall to the extent that water quality could be negatively
impacted.
Existing apparatus for controlling waste need repair or replacement.
Other:
Category III, NO OBSERVED PROBLEMS
X No observed wastewater deficiencies at the time of the site visit.
—' (Piping from the loafing pad to the lagoon had been installed.
Additional work was discussed concerning berming/ditching of the
manure handling site which should be accomplished to insure
containment. Ms. Millie Langley has indicated that she is working
with you on manure waste handling improvements.)
585 Waughtown Street, Winston-Salem, NC 27107-2241 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50`>o recycled/ 10% post -consumer paper �� 9-
fih'�

Page 2
Your cooperation in this matter is greatly appreciated. If you have any
questions about this letter, please do not hesitate to contact Mr. Ron Linville
or me at [phone].
Sincerely,
M. Steven Maune
Water Quality Supervisor
CC, Guilford County S&W Conservation District
central Files
WSRO
a:\clemmer.apr

. Site Requires Igbediate Attention:
'Facility No.
DMSION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: � 0 - , 1995
Time:
Farm Name/Ownt
Mailing Address:
county;,.
Integrator: _ /L` _ _ Phone: /
On Site Representative: , Oa,,, C,Z'0-,n, ►',.ti o,, Phone: 1t/'/­`-zz
Physical Address/Location:
Type of Operation: Swine Poultry Cattle ✓ l7zl.cr��
Design Capacity: .ram Numbe Animals on Site: / z-
DEM Certification Number: ACE &��
erdficad Number; ACNEw
Latitude: Longitude:' " Elevation: Feet '
Circle
Does the Animal Waste Lagoon have sufficie and I Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) Yes or No tual Freeboard: l Ft. Inches
Was any seepage observed from the la is i s)? es Was any erosion observed? Yes or&.
Is adequate land available for spray o Is the cover crop adequate? � '';or No
Crop(s) being utilized:
Does the facility meet SCS minimum
204 Feet from Dwellings? Ves, or No
100 Feet from Wells? es or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or,
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes OT o'
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or Co If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of rnanure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
r
iitional Comments: �: + _ % c�—r_N -� i ^ S
Inspector Name ipai nir
cc: Facility Assessment Unit Use Attachments if Needed.
TOTAL P.02

State of North Carota
Department of Environment,
Health and Natural Resources
Winston-Salem Regional Office
James B. Hunt, Jr., Governor
Jonathan B, Howes, Secretary
Area
1DEiHNF;Z
DIVISION OF ENVIRONMENTAL MANAGEMENT
May 1o, 1996
Mr. Lawrence Clemmer
7059 Holts Store Rd.
Burlington, NC 27215
SUBJECT: Follow Up Farm Inspection
Clemmer Dairy Farm
Guilford County
Dear Mr. Clemmer:
Due to recent concerns about agricultural impacts to waters of the State,
the Division of Environmental Management conducted inspections of all registered
farming operations involving livestock. Mr. Ron Linville of this office in
conjunction with Mr. John Andrews, District MRCS Conservationist visited your
animal operation on April 16, 1996.
Observations at your facility have been categorized as follows:
Category I. NOTICE OF VIOLATION
A wastewater lagoon at your facility has overflowed.
Adequate freeboard (minimum of 1911) is not being maintained in the
lagoon. -
A pipe, ditch or other conveyance can contribute to waste being
discharged from the animal operation.
Operational and Maintenance concerns exist which are likely to cause
animal waste runoff in- a manner that is detrimental to water
quality.
Category II. NOTICE OF CONCERN
Parlor wash, calf feeding or other activities could contribute
negative impacts to water quality..
Loafing areas have the potential to release waste intermixed with
rainfall to the extent that water quality could be negatively
impacted.
Existing apparatus for controlling waste need repair or replacement.
Other:
Category III. NO OBSERVED PROBLEMS
X_ No observed wastewater deficiencies at the time of the site visit.
(Piping from the loafing pad to the lagoon had been 'installed.
Additional work was discussed concerning berming/ditching of the
manure handling site which should be accomplished to insure
containment. Ms. Millie Langley has indicated that she is working
with you on manure waste handling improvements.)
585 Waughtown Street, Winston-Salem, NC 27107-2241 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ ICY% post -consumer paper

u
0
Page 2
If your facility has any Category I NOTICE OF VIOLATION item indicated, it
is necessary that you notify this office in writing by as to the
steps you have initiated or will be taking to rectify the condition(s). Please
be advised that any non -permitted discharge of any type of wastewater to the
waters of the State is illegal per North Carolina General Statute 143-215.1.
Discharges from the lagoons and feedlots must cease immediately. Until
compliance is achieved with the regulations, your Farm will be considered in
violation of GS: 143-215.1 and could be subject to enforcement action with the
possible assessment of civil penalties of up to $10,000 per day per violation.
If your facility has any Category II NOTICE OF CONCERNS, you should notify
the Winston-Salem Regional Office by phone at [phone] to discuss your
progress in resolving water quality concerns by D -- ,- .
For both Category I and II above, this office recommends that you seek the
advice of the Guilford Soil and Water Conservation District at 910/333-5400 prior
to providing a written or verbal response to this office. Your cooperation in
this matter is greatly appreciated. If you have abandoned waste lagoons or
storage ponds, you should consider proper closure of the structures. Operations
below threshold limits may be removed from the registry providing a written
request is submitted to the Division. If you believe that this notification is
in error or if you have any questions about this letter, please do not hesitate
to contact Mr. Ron Linville or me at [phone].
Sincerely,
M. Steven Mauney
Water Quality Supervisor
CC: Guilford County S&W Conservation District
Central Files
WSRO
a:\clemmer.apr

Farm Status: Registered
Farm Name: Hcayrr.-Rill.Farms.......................................
Date;ofdmpectiow Time oHnspection
:14k `UJ c 24 hr. time
p ou me p Mmplaint p Follow-up
County: Guilford ............................................... WSRt;7l.........
Owner Name: Lawreace...............................Clju=er................................................. Phone No: 226-2.63.1.....
Mailing Address: 7059 Holtstore Rd.
Burlington NC
Onsite representative: Gary..Clemmer......................................................................... Integrator: ................................................
Certified Operator Name: ........................................................................
Location of Farm:
27215
Latitude ®•®° ©46 Longitude ®• ©° ®6;
inNot OperationalDate Last Operated: .......................................................................................................................................
Type of Operation and Design Capacity
1. Are there any buffers that need maintenance/improvement? p Yes p No
2. Is any discharge observed from any part of the operation? p Yes ® No
a. If discharge is observed, was the conveyance man-made? p Yes p No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) p Yes p No
c. If discharge is observed, what is the estimated flow in galhn in?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes p No
3. Is there evidence of past discharge from any part of the operation? p Yes p No
4. Was there any adverse impacts to the waters of the State other than from a discharge? p Yes p No
5. Does any part of the waste management system (other than lagoons/holding ponds) require 0 Yes p No
maintenance/improvement?

1
6. Is facility not in compliance with any Wable setback criteria? . Yes ® No
7. Did the facility fail to have a certified operator in responsible charge (if inspection after 1/1/97)? p Yes p No
8. Are there lagoons or storage ponds on site which need to be properly closed?
p Yes
p No
Structures (Lagoons andlor Holding Ponds)
9. Is structural freeboard less than adequate?
p Yes
p No
Freeboard (ft): Lagoon I Lagoon 2 Lagoon 3
Lagoon 4
6
10. Is seepage observed from any of the structures?
p Yes
® No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
p Yes
® No
12. Do any of the structures need maintenance/improvement?
p Yes
p No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adquate markers to identify start and stop pumping levels?
p Yes
p No
Waste Application
14. Is there physical evidence of over application?
p Yes
p No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type
16. Do the active crops differ with those designated in the Animal Waste Management Plan?
p Yes
❑ No
17. Does the facility have a lack of adequate acreage for land application?
p Yes
® No
18. Does the cover crop need improvement?
p Yes
®No
19. Is there a lack of available irrigation equipment?
p Yes
p No
For Certified Facilities Only
20. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
p Yes
p No
21. Does the facility fail to comply with the Animal Waste Management Plan in any way?
p Yes
p No
22. Does record keeping need improvement?
p Yes
p No
23. Does facility require a follow-up visit by same agency?
p Yes
p No
24. Did Reviewer/Inspector fail to discuss review/inspection with owner or operator in charge? p Yes p No
Reviewer/Inspector Name
Revewer/Inspector Signature: Date:

I L
State of North Ca Tina
Department of Environment,
Health and Natural Resources
Winston-Salem Regional Office
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
Leesha Fuller, Regional Manager
MAI
E)EHNR
DIVISION OF ENVIRONMENTAL MANAGEMENT
December 5, 1995
Mr. Lawrence Clemmer
7059 Holts Store Rd.
Burlington, NC 27215
SUBJECT: Written Response to Notice of Violation/Concern
Clemmer Dairy Farm
Guilford County
Dear Mr. Clemmer:
This office is in receipt of your written response to our previous letter
of concern about water quality issues at your farm.
It is our understanding that you will be working with the Guilford County
Soil and Water Conservation District Engineer (Millie Langley) to resolve any
issues relative to this operation. Please be advised that until approval and
implementation of the details of this plan, you should continue to take whatever
operational activities possible to avoid negative impacts to waters'of the State.
Thank you for your timely response and for your efforts in striving to
maintain water quality as it relates to your agricultural operation. If you have
any further needs or questions, please call me at [phone].
Sincere jr ,
an in ille
Environmental Technician IV
CC: Guilford County S&W Conservation District
Central Files
WSRO
a:\Clemmer.res
585 Waughtown Street. Winston-Salem, North Carolina 27107-2241 Telephone [phone] FAX [phone]
An Equal Opportunity Atflrmative Action Employer SD% recycled/ 10% post -consumer paper

BEAVER RILL FARMS, INC.
� ✓�� . �� gg11) Rt. #1, Box 186
Burlington, N. C. 27215 a,!�e
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i
' State of North Carolina
Department of Environment,
Health and Natural Resources
Winston-Salem Regional Office
James B. Hunt, Jr., Governor
Jonathan B, Howes, Secretary
Leesho Faller, Regional Manager
49 MAI
0
ArAil
�Mla
MEHNR
DIVISION OF ENVIRONMENTAL MANAGEMENT
November 22, 1995
CERTIFIED MAIL RP-536-316-593
RETURN RECEIPT REQUESTED
Mr. Lawrence Clemmer
7059 Halts Store Rd.
Burlington, NC 27215
SUBJECT: Farm Inspection Notice of Violation/Concern
Clemmer Dairy Farm
Guilford County
Dear Mr. Clemmer:
Due to recent concerns about agricultural impacts to waters of the State,
the Division of Environmental Management conducted inspections of all registered
farming operations involving livestock. Mr. Ron Linville of this office in
conjunction with Mr. 'John Andrews, District NRCS Conservationist visited your
animal operation on November 1, 1995.
Observations at your facility have been categorized as follows:
Category I. NOTICE OF VIOLATION
A wastewater lagoon at your facility has overflowed.
Adequate freeboard (minimum of 1911) is not being maintained in the
lagoon.
—X_ A pipe, ditch, pad or other conveyance can contribute to waste being
discharged from the animal operation.
operational and Maintenance concerns exist which are likely to cause
animal waste runoff in a manner that is detrimental to water
quality.
k. Category II. NOTICE OF CONCERN
Parlor wash, calf feeding or other activities. could contribute
negative impacts to water quality.
Loafing areas have the potential to release waste intermixed with
rainfall to the extent that water quality could be negatively
impacted.
Existing apparatus for controlling waste need repair or replacement.
Other:
Category III. NO OBSERVED PROBLEMS
No observed wastewater deficiencies at the time of the site visit.:
585 Waughtown Street, Winston-Salem. North Carolina 27107-2241 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer pap r
. (�Yl

Page 2
If your facility has any Category I NOTICE OF VIOLATION item indicated, it
is necessary that you notify this office in writing by December 8, 1995 as to the
steps you have initiated or will be taking to rectify the condition (s). Please
be advised that any non -permitted discharge of any type of wastewater to the
waters of the State is illegal per North Carolina General Statute 143-215.1.
Discharges from the lagoons and feedlots must cease immediately. Until
compliance is achieved with the regulations, your Farm will be considered in
violation of GS: 143-215.1 and could be subject to enforcement action with the
possible assessment of civil penalties of up to $10,000 per day per violation.
If your facility has any Category II NOTICE OF CONCERNS, you should notify
the Winston-Salem Regional Office by phone at [phone] to discuss your
progress in resolving water quality concerns by December 8, 1995. Category III
NO OBSERVED PROBLEMS will not receive any correspondence.
For both Category I and II above, this office recommends that you seek the
advice of the Guilford Soil and Water Conservation District at 910/333-5400 prior
to providing a written or verbal response to this office. Your cooperation in
this matter is greatly appreciated. If you have abandoned waste lagoons or
storage ponds, you should consider proper closure of the structures. Operations
below threshold limits may be removed from the registry providing a written
request is submitted to the Division. If you believe that this notification is
in error or if you have any questions about this letter, please do not hesitate
to contact Mr. Ron Linville or Steve Mauney, Water Quality Supervisor at (910)
771-4600_
Sincerely,
Larry . Coble
Regional Supervisor
CC: Guilford County S&W Conservation District
Central Files
WSRO
a:\clemmer.nov

cRCC-47' Inur di we ALP-enUaa
rsc:litl Number: �l � O
S77 e VISI-rATION RECOPM
Owner, ,o e pVice _ O elb amf r F.. Na,,= -F °em r S
Qn Site Relsrescataclva: �-� � 1✓ l'�Stiac:
Mysical Address • — -oCa GL P �o1 0-� C_lf� mP yr 12
mijiling AddI=z:
Type of Operatioa: Swine
Malign capociiy;Qrl�Nowtj
Lztimde: 3, t o _Q_+ 15
Typv Gmund 1•
Poultry Cattle ✓ t YLA�.
Number of AnimaN cm Sht:
Longitude;_—° 32
Aerial
Circa$ Yes or we
Does tic A:d",-' i Waste 1.agccn hava . tUZIcicat irttcard of 1 Fact + 25 7=24 hour atarr� event
rinr.tr
(aparo f=tely l Foot � 7 inc-has)Fr
Yes r No dal r=x card: Feet incIm
For facilities wills moro th nn = INS(mu, please address the cdzc: lagoons' rrorbvatd undtr the
cctiuncitis Scedon.
Wns any searrap observed Tr3m the lgccit(s)7 Yei o" `N m (Icm cresjon of flz clam?: Yen or(&
Is ad:qucte lard nuoBable rc;r Iaad anpiicatic:n? Yes ar Rio Is ;hc rxivc: crop adegaat*? Yes or No
i
Addiuonal Comments
Fu to (419) 715.3

Site Requires IlMrAatr. Attention:
NWFacility No.
DMSION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATIO]" RECORD
DATE: 5✓1 t 4 1 ,1995
Time: ,L(a 3 �
Farm
Mailing Address: S c 7
County:
Integrator: Phone:
On Site Representative: Phone: /° w
Physical Address/Location: M 7Q .S —3 hil Z-_f e
Type of Operation: Swot Poultry Cattle "^
Design Capacity: �� �-� Number of Animals on Site: lay
DEM Cw tification Number: ACE DEM Certification Number: ACNEW
Latitude: .' , _1!1 " Longitude: jf�_' 33' - 9&" Elevation: . Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour stoma event
(approximately 1 Foot + 7 inches) es No Actual Freeboard: '`Ft, —inches
Was any seepage observed from the lagoon(s)? Yes 00 Was any erosion observed? Yes or Io
Is adequate land available for spray? <&or No Is the cover crop adequate? No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings?�No
100 Feet from Wells? � No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes oi�&a)
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes orq�d-"
Is animal waste discharged into waters of the state by macs -made ditch, flushing system, or other
similar man-made devices? es No If Yes, Please Explain..Ld�y�; - 6Z,, ��
Does the facility maintain adequate waste management records (volumes of manure, Ld applied,
spray irrigated on specific acreage wit=�A�-
crop)? Yes or No
Additional Com�2L--ments: �U r" - `
Inspector Name
cc. Facility Assessment Unit
Use Attachments if Needed.
�t►.:i� C." 4 /c TOTAL P.02

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