Environmental Review Cropland

On-Farm Security Assessment Report

Farm Name Address City, State Zip Date of on-site assessment: DATE

For questions, contact: Validus (515) 278-8002

This assessment was conducted using the assessment tools developed to help assure team members are meeting the requirements for FamilyFarms Certification On-Farm Security Standards. Findings in this assessment are based upon what was observed and measured on the Home Place and storage facilities as defined in the standard. It is the intent of this assessment that items identified as challenges be addressed in order to reduce situations where standards are not met.

The On-Farm Security Assessment reviews items related to:  Crop Storage  Pesticide Storage  Fertilizer Storage  Fuel Storage  Equipment  Identity Preserved Crops

**On the following pages, each piece of each standard must be addressed with an observation, and all challenges noted must have a recommendation directly following.

Audit Sample:  Main crop storage location as distinguished by number of bushels stored, and storage functions at all operating units selected for audit for the “environmental audit”. Standard:  Theft and Bio-terrorism Protection (i.e. locked access points and electrical controls, controlled access to structures, theft deterrent system.)  Location (i.e. contamination precautions, separate from treated seed, not in flood plain)  Sanitation (i.e. weed control, rodent control, spill cleanup and disposal)  Documentation (i.e. personnel with approved access, load and unload amounts and dates, type and volume of chemicals used) Observation(s):  (What did you see at the crop storage facility and what documentation were you able to view?) Challenge(s):  Recommendation(s) to address challenges: 

Audit Sample:  100% of permanent storage structures for all operating units. Standard:  Theft and Use (ie. locked structures, controlled access, original labeled containers with no holes, tears or cracks, PPE.)  Location (i.e. downslope from surface water or well, or meets state regulations for secondary containment and separation distance from water source)  Sanitation and Containment (i.e. triple rinsing of containers, proper disposal, land apply rinseate, stored on an impermeable surface, meets state requirements for secondary containment.)  Permanent Chemical Mixing Areas (i.e. anti-backflow devices, rinseate collection and application, separation distance, secondary containment, impermeable surface with curb.)  Documentation (i.e. personnel with approved access, mixing procedures, names and volume of what is stored, inspection records, spills, state license/certification) Observation(s):  Challenge(s):  Recommendation(s) to address challenges: 

Audit Sample:  100% of permanent storage structures for all operating units. Standard:  Theft and Use (ie. locked structures, controlled access, labeled and enclosed structure, PPE.)  Location (i.e. downslope from surface water or well, or meets state regulations for secondary containment and such conditions are met by concrete pad with curb, design by a licensed engineer and construction approved by state agency, secondary containment as specified by state regulations, storage on an impermeable surface)  Containment (i.e. loading from concrete pad with curb, meets state requirements and designed by licensed professional for secondary containment, storage on an impermeable surface, rainwater and rinseate collected, tested and applied.)  Anhydrous Ammonia (i.e. theft deterrent system, valve locks used, safety release with spring loaded valve, nurse tank hoses removed.)  Documentation (i.e. personnel with approved access, handling and use procedures, inspection records, maintenance records, types and amount stored, state license/certification) Observation(s):  Challenge(s):  Recommendation(s) to address challenges: 

Audit Sample:  Main fuel storage structure(s) as distinguished by number of gallons stored, and all operating units selected for audit for the “environmental audit”. Standard:  Theft and Bio-terrorism Protection (i.e. locked electrical controls, controlled access to structures, theft deterrent system, fire extinguishers within 75 feet, no abandon tanks or leaking hoses, functioning gauges.)  Location (i.e. downslope from surface water or well, or meets state requirements for secondary containment and meet state requirements for separation distance, proper safety signage, outside of flood plain and high-water table)  Containment (i.e. state requirements for secondary containment and proper ventilation, SPCC, underground structures include vaults and tested for leaks.)  Documentation (i.e. personnel with approved access, inspection and testing, SPCC plan) Observation(s):  Challenge(s):  Recommendation(s) to address challenges: 

Audit Sample:  100% of planting and harvesting equipment. Standard:  General (ie. fire extinguishers located on all tractors and combines)  Documentation (i.e. dates and type of maintenance performed on equipment and fire extinguishers) Observation(s):  Challenge(s):  Recommendation(s) to address challenges: 

7.0 Identity Preserved Crops

Audit Sample:  Crops contracted for attributes related to identity preservation. Standard:  Storage (i.e. identify source field per structure or location, GMO separation, not stored in piles or bags)  Sanitation (i.e. structure, loading, planting and harvesting equipment and pit house/dump cleanout)  Documentation (i.e. Procedure for cleaning practices, date per structure, pit house/dump, loading/unloading equipment, planting harvesting equipment wash/cleanout.) Observation(s):  Challenge(s):  Recommendation(s) to address challenges: 

The following is a summary of recommendations that will help improve the on- farm security performance of this operation to be within the FamilyFarms Certification On-Farm Security Standards:

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Assessor Signature: ______Date: ______