####### NE-CPA-42 Slurry or Sludge Application Field Record 4/01

Farm Owner: [     ]{.underline} Livestock/Poultry Facility:
[     ]{.underline} Year[:     ]{.underline}

Manure Applicator: [     ]{.underline} Net Load Capacity:
[     ]{.underline} gallons

<table>
<colgroup>
<col style="width: 6%" />
<col style="width: 8%" />
<col style="width: 14%" />
<col style="width: 9%" />
<col style="width: 12%" />
<col style="width: 7%" />
<col style="width: 6%" />
<col style="width: 8%" />
<col style="width: 19%" />
<col style="width: 5%" />
</colgroup>
<tbody>
<tr class="odd">
<td>Date</td>
<td>Field ID</td>
<td>Number of Loads</td>
<td>Is Storage Agitated During Pump Out?</td>
<td>Is Manure Incorporated into Soil?</td>
<td>Area Covered (acres)</td>
<td>Wind Direction from:</td>
<td>Set backs maintained</td>
<td>Soil/Field Conditions</td>
<td>Operator Initials</td>
</tr>
<tr class="even">
<td></td>
<td><h1 id="pivot-1">Pivot 1</h1></td>
<td>/ / / / / / / / / / /</td>
<td><p>Yes</p>
<p>No</p></td>
<td><p>Yes,</p>
<p>    days</p>
<p>No later</p></td>
<td>8 acre</td>
<td>SE</td>
<td>30’ from stream</td>
<td><p>Frozen Snow-covered</p>
<p> Wet Moist</p>
<p> Dry</p></td>
<td></td>
</tr>
<tr class="odd">
<td>     </td>
<td>     </td>
<td></td>
<td><p>Yes</p>
<p>No</p></td>
<td><p>Yes,</p>
<p>    days</p>
<p>No later</p></td>
<td>     </td>
<td>     </td>
<td>              </td>
<td><p>Frozen Snow-covered</p>
<p> Wet Moist</p>
<p> Dry</p></td>
<td></td>
</tr>
<tr class="even">
<td>     </td>
<td>     </td>
<td></td>
<td><p>Yes</p>
<p>No</p></td>
<td><p>Yes,</p>
<p>    days</p>
<p>No later</p></td>
<td>     </td>
<td>     </td>
<td>              </td>
<td><p>Frozen Snow-covered</p>
<p> Wet Moist</p>
<p> Dry</p></td>
<td></td>
</tr>
<tr class="odd">
<td>     </td>
<td>     </td>
<td></td>
<td><p>Yes</p>
<p>No</p></td>
<td><p>Yes,</p>
<p>    days</p>
<p>No later</p></td>
<td>     </td>
<td>     </td>
<td>              </td>
<td><p>Frozen Snow-covered</p>
<p> Wet Moist</p>
<p> Dry</p></td>
<td></td>
</tr>
<tr class="even">
<td>     </td>
<td>     </td>
<td></td>
<td><p>Yes</p>
<p>No</p></td>
<td><p>Yes,</p>
<p>    days</p>
<p>No later</p></td>
<td>     </td>
<td>     </td>
<td>              </td>
<td><p>Frozen Snow-covered</p>
<p> Wet Moist</p>
<p> Dry</p></td>
<td></td>
</tr>
<tr class="odd">
<td>     </td>
<td>     </td>
<td></td>
<td><p>Yes</p>
<p>No</p></td>
<td><p>Yes,</p>
<p>    days</p>
<p>No later</p></td>
<td>     </td>
<td>     </td>
<td>              </td>
<td><p>Frozen Snow-covered</p>
<p> Wet Moist</p>
<p> Dry</p></td>
<td></td>
</tr>
<tr class="even">
<td>     </td>
<td>     </td>
<td></td>
<td><p>Yes</p>
<p>No</p></td>
<td><p>Yes,</p>
<p>    days</p>
<p>No later</p></td>
<td>     </td>
<td>     </td>
<td>              </td>
<td><p>Frozen Snow-covered</p>
<p> Wet Moist</p>
<p> Dry</p></td>
<td></td>
</tr>
<tr class="odd">
<td>     </td>
<td>     </td>
<td></td>
<td><p>Yes</p>
<p>No</p></td>
<td><p>Yes,</p>
<p>    days</p>
<p>No later</p></td>
<td>     </td>
<td>     </td>
<td>              </td>
<td><p>Frozen Snow-covered</p>
<p> Wet Moist</p>
<p> Dry</p></td>
<td></td>
</tr>
<tr class="even">
<td>     </td>
<td>     </td>
<td></td>
<td><p>Yes</p>
<p>No</p></td>
<td><p>Yes,</p>
<p>    days</p>
<p>No later</p></td>
<td>     </td>
<td>     </td>
<td>              </td>
<td><p>Frozen Snow-covered</p>
<p> Wet Moist</p>
<p> Dry</p></td>
<td></td>
</tr>
<tr class="odd">
<td>     </td>
<td>     </td>
<td></td>
<td><p>Yes</p>
<p>No</p></td>
<td><p>Yes,</p>
<p>    days</p>
<p>No later</p></td>
<td>     </td>
<td>     </td>
<td>              </td>
<td><p>Frozen Snow-covered</p>
<p> Wet Moist</p>
<p> Dry</p></td>
<td></td>
</tr>
<tr class="even">
<td>     </td>
<td>     </td>
<td></td>
<td><p>Yes</p>
<p>No</p></td>
<td><p>Yes,</p>
<p>    days</p>
<p>No later</p></td>
<td>     </td>
<td>     </td>
<td>              </td>
<td><p>Frozen Snow-covered</p>
<p> Wet Moist</p>
<p> Dry</p></td>
<td></td>
</tr>
<tr class="odd">
<td>     </td>
<td>     </td>
<td></td>
<td><p>Yes</p>
<p>No</p></td>
<td><p>Yes,</p>
<p>    days</p>
<p>No later</p></td>
<td>     </td>
<td>     </td>
<td>              </td>
<td><p>Frozen Snow-covered</p>
<p> Wet Moist</p>
<p> Dry</p></td>
<td></td>
</tr>
<tr class="even">
<td>     </td>
<td>     </td>
<td></td>
<td><p>Yes</p>
<p>No</p></td>
<td><p>Yes,</p>
<p>    days</p>
<p>No later</p></td>
<td>     </td>
<td>     </td>
<td>              </td>
<td><p>Frozen Snow-covered</p>
<p> Wet Moist</p>
<p> Dry</p></td>
<td></td>
</tr>
<tr class="odd">
<td>     </td>
<td>     </td>
<td></td>
<td><p>Yes</p>
<p>No</p></td>
<td><p>Yes,</p>
<p>    days</p>
<p>No later</p></td>
<td>     </td>
<td>     </td>
<td>              </td>
<td><p>Frozen Snow-covered</p>
<p> Wet Moist</p>
<p> Dry</p></td>
<td></td>
</tr>
<tr class="even">
<td>     </td>
<td>     </td>
<td></td>
<td><p>Yes</p>
<p>No</p></td>
<td><p>Yes,</p>
<p>    days</p>
<p>No later</p></td>
<td>     </td>
<td>     </td>
<td>              </td>
<td><p>Frozen Snow-covered</p>
<p> Wet Moist</p>
<p> Dry</p></td>
<td></td>
</tr>
<tr class="odd">
<td>     </td>
<td>     </td>
<td></td>
<td><p>Yes</p>
<p>No</p></td>
<td><p>Yes,</p>
<p>    days</p>
<p>No later</p></td>
<td>     </td>
<td>     </td>
<td>              </td>
<td><p>Frozen Snow-covered</p>
<p> Wet Moist</p>
<p> Dry</p></td>
<td></td>
</tr>
<tr class="even">
<td>     </td>
<td>     </td>
<td></td>
<td><p>Yes</p>
<p>No</p></td>
<td><p>Yes,</p>
<p>    days</p>
<p>No later</p></td>
<td>     </td>
<td>     </td>
<td>              </td>
<td><p>Frozen Snow-covered</p>
<p> Wet Moist</p>
<p> Dry</p></td>
<td></td>
</tr>
<tr class="odd">
<td>     </td>
<td>     </td>
<td></td>
<td><p>Yes</p>
<p>No</p></td>
<td><p>Yes,</p>
<p>    days</p>
<p>No later</p></td>
<td>     </td>
<td>     </td>
<td>              </td>
<td><p>Frozen Snow-covered</p>
<p> Wet Moist</p>
<p> Dry</p></td>
<td></td>
</tr>
<tr class="even">
<td>     </td>
<td>     </td>
<td></td>
<td><p>Yes</p>
<p>No</p></td>
<td><p>Yes,</p>
<p>    days</p>
<p>No later</p></td>
<td>     </td>
<td>     </td>
<td>              </td>
<td><p>Frozen Snow-covered</p>
<p> Wet Moist</p>
<p> Dry</p></td>
<td></td>
</tr>
<tr class="odd">
<td>     </td>
<td>     </td>
<td></td>
<td><p>Yes</p>
<p>No</p></td>
<td><p>Yes,</p>
<p>    days</p>
<p>No later</p></td>
<td>     </td>
<td>     </td>
<td>              </td>
<td><p>Frozen Snow-covered</p>
<p> Wet Moist</p>
<p> Dry</p></td>
<td></td>
</tr>
<tr class="even">
<td>     </td>
<td>     </td>
<td></td>
<td><p>Yes</p>
<p>No</p></td>
<td><p>Yes,</p>
<p>    days</p>
<p>No later</p></td>
<td>     </td>
<td>     </td>
<td>              </td>
<td><p>Frozen Snow-covered</p>
<p> Wet Moist</p>
<p> Dry</p></td>
<td></td>
</tr>
<tr class="odd">
<td>     </td>
<td>     </td>
<td></td>
<td><p>Yes</p>
<p>No</p></td>
<td><p>Yes,</p>
<p>    days</p>
<p>No later</p></td>
<td>     </td>
<td>     </td>
<td>              </td>
<td><p>Frozen Snow-covered</p>
<p> Wet Moist</p>
<p> Dry</p></td>
<td></td>
</tr>
<tr class="even">
<td>     </td>
<td>     </td>
<td></td>
<td><p>Yes</p>
<p>No</p></td>
<td><p>Yes,</p>
<p>    days</p>
<p>No later</p></td>
<td>     </td>
<td>     </td>
<td>              </td>
<td><p>Frozen Snow-covered</p>
<p> Wet Moist</p>
<p> Dry</p></td>
<td></td>
</tr>
<tr class="odd">
<td>     </td>
<td>     </td>
<td></td>
<td><p>Yes</p>
<p>No</p></td>
<td><p>Yes,</p>
<p>    days</p>
<p>No later</p></td>
<td>     </td>
<td>     </td>
<td>              </td>
<td><p>Frozen Snow-covered</p>
<p> Wet Moist</p>
<p> Dry</p></td>
<td></td>
</tr>
<tr class="even">
<td>     </td>
<td>     </td>
<td></td>
<td><p>Yes</p>
<p>No</p></td>
<td><p>Yes,</p>
<p>    days</p>
<p>No later</p></td>
<td>     </td>
<td>     </td>
<td>              </td>
<td><p>Frozen Snow-covered</p>
<p> Wet Moist</p>
<p> Dry</p></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="9">The minimum distance between the manure application area
and any stream, lake, wells, impounded waters or wetlands was      
feet.</td>
<td></td>
</tr>
</tbody>
</table>