720017_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

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State of North Carolina
Department of Environment and
Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Wayne McDevitt, Secretary
Kerr T. Stevens, Director
May 3, 1999
Mr. Dean Lane
Stone Landing Farm
Rt, 1, Box 4-B
Belvidere, NC 27919
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CIE�km-rmcNr NORROLINA
ENVIRONIKl=NT ANO NATURAL R1=5oLJRCES
SUBJECT: Animal Feedlot Operation Compliance Inspection
Stone Landing Farm
Facility No. 72 -17
Perquimans County
Dear Mr. Lane:
On March 24, 1999, 1 conducted an Animal Feedlot Operation Compliance Inspection at the referenced
facility. Overall, the operation was found to be in satisfactory condition_. A copy of the inspection report is
attached for your review.
In general, this inspection includes verifying that: (1) the farm has a Certified Animal Waste Management
Plan (CAWMP); (2) the farm is complying with requirements of the State Rules 15 NCAC 21102I7, Senate
Bill 1217, and the Certified Animal Waste Management Plan; (3) the farm operation's waste management
system is being operated properly under the direction of a Certified Operator, (4) the required records are
being kept; (5) there are no signs of seepage; erosion, and/or runoff.
The recommendations and/or comments regarding your inspection can be found in the comment section of the
attached inspection form. It is very important as the owner and Operator in Charge that you address any noted
concerns, as soon as possible. For assistance, please contact your Technical Specialist and/or the local Soil &
Water Conservation District Office.
Thank you for your cooperation and assistance during the inspection. Should you have further questions or
comments regarding this inspection, do not hesitate to call me at [phone], ext. 321.
Sincerely,
Daphne B. Cullom
Environmental Specialist 11
cc: Perquimans County SWCD Office
,%WaRO
943 Washington Square Mall, Washington, North Carolina 27889
Telephone 252/946-Wl FAX [phone]
An Equal Opportunity Affirmative Action Employer

Facility Number Date of Inspection
Time of Inspection 24 hr. (hh:mm)
p Permitted E Certified a Conditionally Certified p Registered 10 Not perat�ona Date Last Operated: ...........................
Farm Name: Stone.Landing.Earm................................................................................... County: Perquimans WARO
Owner Name: l?Ala..................Its........................ . Phone No: 2?...$9.2....................................................................
FacilityContact:...............................................................................Title:..........................................._................... Phone No:....................................................
MailingAddress: fit... oX..4.-..................................................................................... . ��yl44gt�. '. ......................_.._. 17. y.?.............
Onsite Representative: Dxan.Lane..........
.. integrator:
Certified Operator: p�ii.Il.................................... UmV .................................................. Operator Certification Number: 1.Q 7................_.._.........
Location of Farm:
AL
yxy.32.fri.m... .infall.go.4.miles.toga.rd.BeLvidere....l.rom.WintaRi''m.:an.the.lcft. and.slide-oflbe.rnad..................... ................... _
.......... .................. ..........
Latitude Longitude
Swine Capacity Population
❑Wean
to Feeder
❑
Feeder to
Finish
❑
Farrow to
can
®
P arrow to
er
80
20
❑
arrow to
Hnish
❑
1 is
❑
Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ ayer I I❑ airy
❑ Non -Layer I 1 1 JE3 on- airy
❑ uIner 1 l I
Total Design Capacity SO
Number of Lagoons ] 1 I❑ Subsurlace Drains Pi
Holding Ponds / Solid Traps p o �qui aste a
Dischar¢es & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
Total SSLW
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
pray r MCI Area I
[]Yes N No
❑ Yes ❑ No
❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of 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?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: .................................................................... ..... ..... .............................
Freeboard(inches): ...............5.Q.....................................................................................................
❑ Yes ❑ No
❑ Yes ® No
❑ Yes N No
❑ Yes N No
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3/23/99
❑ Yes ® No
Continued on back

i
Facility Number: 72-17 Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type Cotton
® No
❑ Yes
❑ Yes
® No
❑ Yes
®No
❑ Yes
®No
❑ Yes
®No
p Yes
®No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. is there a lack of adequate waste application equipment?
Required Records & Documents
IT Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
3. No. violations_ or:defieieincies. were noted: daring this. visit.- Vou.will receive: no; furilier. .
...correspondence about this: visit.
5. Cedar trees will need to be removed when you receive you General permit continue to establish vegetation on
Watch out for eroding areas.
5. Mr. Lane may be closing out his recycle lagoon.
S. Mr. Lane has seeded open lot as directed by Lyn Hardison during the last DWQ Compliance Inspection.
13. WUP has been updated to include cotton.
14. A WA determination is not needed at this facility.
17 & 22. Facility has not received application for General Permit as of the date of this inspection.
If you have any questions about this inspection, please contact me at [phone], ext. 321.
❑ Yes IS No
❑ Yes ® No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes ® No
❑Yes ❑No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes ❑ No
❑ Yes R No
p Yes N No
❑ Yes N No
Reviewer/InspectorName DaphneB:Cullom --�-- -��— --' - .7
Reviewer/Inspector Signature: _ o _ (t. Date- --3 — _n _ c� q W +

Routine
Of
Facility Number 72 17
Q Registered M Certified © Applied for Permit E3 Permitted
ow -up of DSWC review Q Other
Date of Inspection io/7198
Time of Inspection 10:110 24 hr. (hh:mm)
Not Operational I Date Last Operated:
Farm Name: %mmJ wWiug.Fa.................................................................................. County: Forgulmam .................................... W.R.Q.......
OwnerName: Dj=........................................ Lane ............................................................. Phone No: 291:2592 ....................................................................
FacilityContact: .............................................................................. Title:................................................................ Phone No:...................................................
Mailing Address: Rx..1.Idax.4rB.......................................................................................... BrJyid.NC............------........... .. 7.79.19 .............
Onsite Representative: DczaLanc................................................. Integrator:
Certified Operator: DeanN................................... Lmm .................................................. Operator Certification Number: .19,3b7..............................
Location of Farm:
Latitude 36 ' 14d 51 Longitude 76 •F 31 19 K
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
® Farrow to Feeder 80 30
❑ Farrow to Finish
❑ Gilts
❑ Boars
General
1. Are there any buffers that need maintenancelimprovement?
❑ Yes
® No
2. Is any discharge observed from any part of the operation?
❑ Yes
IN 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 Surface Water? (If yes, notify DWQ)
❑ Yes
❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
©No
3_ Is there evidence of past discharge from any part of the operation?
❑ Yes
N No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
[@ No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
® No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
R No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
® No
7/25/97

Facility Number: 72-17 Date of Inspection I 1017198
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons.Holding Ponds, Flush Pits, etc)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3 Structure 4
❑ Yes ® No
❑ Yes ® No
Structure 5 Structure 6
Identifier.................. ................... ..............
Freeboard (11): ...............6,, .............. .....................
10. Is seepage observed from any of the structures? ❑ Yes ® No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes ® No
12. Do any of the structures need maintenance/unprovement?
(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 adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type.........................................................................................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18, Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes ® No
[] Yes 0 No
❑ Yes OR No
❑ Yes
® No
❑ Yes
®No
© Yes
®No
❑ Yes
®No
❑ Yes
® No
❑ Yes
® No
❑ Yes
H No
❑ Yes
® No
❑ Yes
® No
❑ Yes
M No
U No --violations' air'de%Cieiicies•wbre'n'oted.dulring this.visit. - Y4u-Vvfi1'rkteiVe _n?O farther' . .
..:caxres:poedence af>Eouf •t�is:visiti• :.. • . - . - - � - ............... ... - .. .
will be revised to add cotton as an irrigated crop.
a plan for dry lot rotation will be added.
IVI
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:

C
JDesign ,_ ... Current�
:CApaft Population,
❑Division of Soil and Water Conservation [3Other Agency
Division of Water Quality
V 7
14DRoutine OComolaint 0Follow-upofDoi` Qins pectiou 0 Follow-up of DSWC review 00ther
Date of Inspection
Facility Number
I I . I Time of Inspection i 2 Zd 24 hr. (hh:mm)
13 Registered El Certified [3 Applied for Permit 13 Permitted 10 Not Operational Date Last Operated: ..........................
Farm Name: ...... :e:l . ........ 1:;;V Jn. Countv:_.,?.,j".. y�� ....................
$ ...... x ...............................................
Owner Name: ......... L)"A., ...................................Z�a-� ............................................ Phone No:..... ...... Z01 - 2647 -2—
.....................................................
FacilityContact: .............................................................................. Title: ................................................................ Phone No:
Mailing Address: ..... ......... ....... ................................................. .... 6JL!Y#, pic'. Z79
.............................................. .............9.........
Onsite Representative: .... .................................. La.1.1 ......................................... Integrator: ..... .. )1dV.4.07
............ L .... . ............................ ..............
Certified Operator . ........ t>en ......... W ........... ......... (".- 3,67
" f ............................... I ..... Operator Certification Number L13 .......... .................
..........
Location of Farm:
Latitti.de Longitude
Design I,, ..Current Design .' Current
Capacity Population Capacity opu ation 'Cattle Swine- Poultry I'
[J Wean to Feeder
El Feeder to Finish
C1 Farrow to Wean
Farrow to Feeder
❑ Farrow to Finish
,0 Gilts
I[] Boars
General
1. Are there any buffers that need maintenance/improvement? 0 Yes allo
2. Is any discharge observed from any part of the operation?
Discharge originated at: El Lagoon' 0 Spray Field 0 Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes.. notify DWQ)
c. If discharge is observed, what , is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge? -
5. Does any part of the waste management system (other than lagoonstholding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
0 Yes 91 No
rl Yes
RNo
❑ Yes
0 No
11 t4_ ,
0 Yes
IRNo
D Yes
91 No
0 Yes
R[No
0 Yes
in No
0 Yes ONo
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
El Yes Eff No
Continued on back

Facility Number'-7L -
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons.11olding fonds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes .2 No
❑ Yes 91 No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (tt):
10. Is seepage observed from any of the structures? ❑ Yes E3 No
11. Is erosion, or any other threats to the integrity of any of the structures observed? „Yes ❑ No
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 wasanswered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the -structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State. notify DWQ)
IS. Crop type .......�I&A .....................
16. Do the receiving crops differ with those designate5�t� m Waste Ma�m��lan (A MP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22: Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does. the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0 No.violations or deficiencies4ere noted during this. visit.- :You.will receive no further
correspondence about this'.
visit'.
.l Yes ❑ No
❑ Yes [?No
❑ Yes 19 No
['Yes ❑ No
❑ Yes - \To
❑ Yes R-No
❑ Yes E!�No
❑ Yes [s_.\To
❑ Yes. �o
.[ 'Yes ❑ No
❑ Yes BNo
KYes ❑ No
❑ Yes �\i To
Cominents`_(refer to question #) wExplain any IVES answers a'nd/or anF recommendations or any tither comments ;A
Use draw`�n s of facrht tobetter`ex lain situations use additional a es as necessa`ry fix
alb - �v{i`�tPP ia.��r�v i`+z.c.l�� r���... �- �-�-.� ��-�- Lr� � s wc!/ a_� df•�.�-z.
..
i t , j Z r
�.�
I 15�
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: �- - 9

State of North Carolina
Department of Environment,
Health and Natural Resources 4
Division of Water Quality
James B. Hunt, Jr., Governor
Wayne McDevitt, Secretary
A. Preston Howard, Jr., P.E., Director
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
August 11, 1997
Mr. Dean N. Lane
Stone Landing Farm
Route 1, Box 4-13
Belvidere, NC 27919
SUBJECT: Animal Feedlot Operation Site Inspection
Stone Landing Farm
Facility No. 72-17
Perquimans County
Dear Mr. Lane:
On April 16, 1997, I conducted an Animal Feedlot Operation Site Inspection at Stone Landing
Farm in Perquimans County. Overall, the operation was found to be in satisfactory condition. A
copy of the inspection report is attached for your review.
In general, this inspection included verifying that: (1) the farm has a Certified Animal Waste
Management Plan (CAWMP); (2) the faun is complying with requirements of the State Rules 15
NCAC 21-1.0217, Senate Bill 1217, and the Certified Animal Waste Management Plan; (3) the farm
operation's waste management system is being operated properly under the direction of a Certified
Operator; (4) the required records are being kept; (5) there are no signs of seepage, erosion, and/or
runoff. The following deficiencies were observed during the inspection.
I . There were approx. 160 farrow to finish onsite. The animals are rotated from the ground to
a house. The animals on the ground are no rotated between different paddocks (areas) and
there is not an established vegetative cover on the ground. There is a twenty-five foot
buffer between the open lots and the canal.
2. The farm is certified and the Certified Animal,Waste Management Plan (CAWMP) did not
contain all the necessary components, such as: design needs and measurements, the
operation and maintenance plan and the odor, insect and mortality checklist. Please take
time to review the enclosed CAWMP component list and gather'the necessary items from
the County's NRCS office.
943 Washington Square Mall, Washington North Carolina 27889 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer

A
if
Mr. Dean N. Lane
Stone Landing Farm
August 11, 1997
Page 2
3. It was understood that animal waste had not been land applied over this past year. For you
information, irrigation records are required and forms IRR 1 and IRR 2 should be used. In
addition, soil analysis is required annually and waste analysis is required within sixty days
of application.
4. The Certified Plan indicated that the designated crops are corn and wheat and the method of
application is a reel system with hydrants onto land that surrounds the farm.
5. The second lagoon is almost never used and there is an interest to possibly close out this
lagoon. For your reference I've enclosed NRCS guidance on closures.
As a reminder, a minimum of nineteen inches of freeboard must be maintained in the lagoon and it
is required to maintain a buffer of twenty-five feet while spray irrigating from any drainage system
(ditch, swale, canal, stream, etc.). Please be aware that it is a violation of North Carolina General
Statutes to discharge wastewater to the surface waters (farm ditches, creeks, streams, etc) of the
State without a permit. The Division of Water Quality has the authority to levy a fine of not more
than $10,000 per day for the unpermitted discharge of wastewater into the surface waters of the
State.
For additional assistance, please contact your Technical Specialist and/or the local Soil & Water
Conservation District Office. Thank you for your cooperation and assistance during the
inspection. Should you have further questions or comments regarding this inspection, do not
hesitate to call me at [phone], ext. 318.
Sincerely,
�J
Lyn B. Hardison,
Environmental Specialist
cc: Perquimans County SWCD Office
DSWC-WaRO, w/out attachments
Compliance Group, w/out attachments
WQ Central Files, w/out attachments
WaRO (2), w/out attachments

f
le outine p roinpiaint p Follow-up of DWQ inspection p o ow -up of DSWU review p ter
Date of Inspection
Facility Number
Time of Inspection 1500 24 hr. (hh:mm)
Faun Status: Certified
Farm:Name: Stoue.Landing.F.arm..........................................................
OwnerMime: Dean ........................................ Lane ....................................
County: Perquimans WARO
PhoneNo: 291-.259.2....................................................................
MailingAddress: Rt..1..113ux-A-B....................... :.................................................................. Helvidrue-NC......................................................... 2.794.9 ..............
Onsite Representative: Dean -Lane .ane................................................................................... Integrator:.......................................................................................
Certified Operator:Dean.N.................................. Lane ................................................... Operator Certification Number: 19367.............................
Location of Farm:
A
4
Latitude ®s ®L ©« Longitude ©c ®44
toMilt Operalional (late Last Operated:............................................................................................................................................................
Type of Operation and Design Capacity
C;eneral
I. Are there any buffers that need maintenance/improvement? ® Yes ® No
2. Is any discharge observed from any part of the operation?
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, whal is the esdinaled Ilow in gallmin?
d. Does discharge bypass a lagoon system? (Il'ycs, nobly DWQ)
1 Is there evidence of past discharge from any part of the operation?
d. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
❑ Yes ® No
p Yes ❑ No
p Yes ❑ No
[]Yes ❑ No
❑ Yes ® No
[]Yes ® No
® Yes ❑ No

6. Is facility not in compliance with any applicable setback criteria?
7. Did the facility fail to have a certified operator in responsible charge (if inspection after 1/l/97)?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Siruclu.res (Lagoons and/or Holding Ponds)
9. is structural freeboard less than adequate?
Freeboard (ft): Lagoon I Lagoon 2 Lagoon 3
................4.0.............................4.0................ ........... I...................
10. Is seepage observed from any of the structures?
I__ 11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(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?
Waste Application
14. Is there physical evidence of over application?
(1f in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ............... Corn.(Silage.,&..Graial.................Sinali.Grain.(Wheat, l arEay.,.Mila...
16. Do the active crops differ with those designated -in the Animal Waste Management Plan?
17. Does the facility have a lack of adequate acreage for land application?
18: Does the cover crop need improvement?
19. Is there a lack of available irrigation equipment?
For Certified Facilities Only
20. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
21. Does the facility fail to comply with the Animal Waste. Management Plan in any way?
22. Does record keeping need improvement?
23. Does facility require a follow-up visit by same agency?
24. Did Reviewer/Inspector fail to discuss review/inspection with owner or operator in charge?
Reviewer/Inspector Name yn.. _ n
® Yes Illt No
p Yes N No
® Yes ® No
p Yes N No
Lagoon 4
p Yes ® No
p Yes ® No
[]Yes ® No
p Yes N No
[]Yes ® No
p Yes ® No
p Yes M No
p Yes ® No
p Yes ® No
® Yes
p No
p Yes
® No
p Yes
® No
13 Yes
R No
p Yes
R No
Reviewer/Inspector Signature: - Date: