* Manure (Cattle, Hog, Poultry, Horse, Etc.)

Agricultural Inputs

Instructions: Includes all applications from pre-planting through to, and including, harvest. One Form must be completed for EACH PRODUCTION SITE.

Producer Name: Previous Year Crop(s): Current Crop:

Production Site Information (e.g., Field # or Name/ID): Production Site Area Date Planted: Variety:

(e.g., # of acres/hectares):

COMMERCIAL FERTILIZER APPLICATION

Date Blend Rate Fertilizer Lot # (if applicable) Applicator’s Name

 Canadian Horticultural Council, Combined Vegetable Producer, Storage Intermediary and Packer On-Farm Food Safety Manual, Version 4.0, 2010, Canadian Horticultural Council. Agricultural Inputs

MANURE*/COMPOST/COMPOST TEA/OTHER BY-PRODUCTS/PULP SLUDGE#/SOIL AMENDMENT/MULCH APPLICATIONS

Earliest Allowable Harvest Date* (according to Date What is Applied Type* Supplier’s Name Rate appropriate time delay) Applicator’s Name

* Manure (cattle, hog, poultry, horse, etc.)

# Pulp sludge is the solid residue that remains after wastewater is treated at pulp and paper mills. It mainly consists of wood fibre, lime, and clays, as well as excess organisms produced as part of the wastewater treatment process.

 Other by-product (seafood waste, vegetable culls, etc.)

 Canadian Horticultural Council, Combined Vegetable Producer, Storage Intermediary and Packer On-Farm Food Safety Manual, Version 4.0, 2010, Canadian Horticultural Council.