<p> COMBINE CLEAN-OUT AFFIDAVIT</p><p>Please complete a clean-out affidavit before harvest and for each different crop harvested. Note field numbers and date clean-out procedures were performed.</p><p>Producer Clean-Out Date ______</p><p>Crop ______Field Number ______</p><p>Custom Operator Name ______</p><p>Address ______</p><p>Type of Machine ______</p><p>Clean-out Procedure: (S) Sweeping; (C) Compressed air; (W) Washing Please mark each part of the combine that was cleaned and the procedure used.</p><p>Header Sieves and Chaffers Feederhouse Cylinder and/or Rotor Grain Tank Shoe Supply Augers Straw Walkers Unloading Auger Ledges, Frame Rails Rock Trap Clean and Return Elevators and Cross Augers</p><p>I hereby attest that the above practices and procedures have been completed in accordance with OCIA Standards.</p><p>Operator Producer</p><p>DateDate</p><p>(Attach a copy of the invoice for contracted services.) Use of this form is optional. Another form accomplishing the same purpose may be used if appropriate to your operation.</p><p>EN-NQ-F-022, Revision A Combine Clean-Out Affidavit Page 1 of 1 Effective Date: 23 February 2002 © 2002 by OCIA International, Inc.</p>