Agricultural Registration/ Renewal 2012

TO SEND BACK

AGRICULTURAL REGISTRATION/ RENEWAL 2012 Crops, greenhouses, livestock

REMINDER Please return this form before April 30th 2012.

ATTENTION: All new site registrations must be accompanied by a map of the new fields.

Nature of the request Renewal Pre-certification Maintenance Visit: Please keep my file open without product certification in 2012 Preferred period or date of inspection: (There is no guarantee that the Inspector will be available this day)

Internal Current Information Client number: use Name: Legal name: Organic manager: Title: Second contact: Address: City: Postal Phone: Province: code: Fax: e-mail: Cell phone: Web site:

Existing client: Products certified in 2011: Changes to products to be certified in 2012:

New client: I request the certification for all products marked as « to be certified » in the production plan below: Yes No specify:

Data update: 1.Has your production site address changed? Yes No If yes, specify: Address, phone and fax:

Agricultural renewal version 01-12-2011 Page 1 of 9 TO SEND BACK

2. Number of sites to visit: Please indicate additional site addresses below:

Type of production on site: Street Phone Town or village Postal code Type of production on site: Street Phone Town or village Postal code

3. Name to appear on your certificate if different from above:(Provide proof of registration)

4. Additional standards: Basic certification is according to CARTV and COS + organic standards. These standards give you access to Canadian, American and European* markets. Requests for additional standards made following the regular annual inspection will result in additional costs and a second inspection. Your buyers can help you with this section. *100% Canadian products only Additional standards requested: BioSuisse (Switzerland) Name and address of importer: JAS (Japan):

5. List of personnel in charge that are able to answer questions, sign the inspection report during regular or unannounced inspections. (He or she must be able to answer questions and provide documents related to the inspection) Name Position

New clients please complete this section N/A Have any of your products been certified or pre-certified in the last 5 years? No Yes Name of certification body: Year: Are your products currently certified? No Yes Name of certification body: Has the certification of any of your products ever been suspended, withdrawn or denied in the past? No Yes If yes, complete the grid below: Certification Body Year Product(s) Reasons for Suspension

Please ask your current certifier to send us a copy of your file with report, decision, and certificate. (Must be received from your certification body)

General Production Plan 2012 (Please complete for all types of production)

1. Clients who are currently certified: Please provide a brief description of the actions taken to resolve the non-compliances from the past year:

2. List of subcontractors used Type of operation Company Name and Address

3. Records Present Fields records Yes No N/A Livestock health records Yes No N/A Sales records Yes No N/A Complaints records Yes No N/A Equipment maintenance records Yes No N/A Compost records Yes No N/A

4. Product Traceability (lot number) Is a traceability system in place (including lot numbers)? Yes No N/A

5. Please list any crops from the previous year still in storage on the farm Product Quantity Status (organic, Storage site Lot no. (if transition, Conv.) applicable)

6. Product labelling: Is the company name always indicated on the product labels? Yes No If not please complete the information below: Product name Trademark Any other identification code used (specify ACIA, MAPAQ, customer #)

Please provide proof of registered trademarks

Crop production plan 2012

1. This certification request applies to the following (please check all that apply) Crops Orchards Vegetables Greenhouses Hay Wild harvest Others :

2. 2012 Crops (indicate organic and non-organic areas) Crop (include all land in Status Area in production (indicate production) unit) Number Acres Ha Org in transition Conventional Org in transition Conventional Org in transition Conventional Org in transition Conventional Org in transition Conventional Org in transition Conventional Org in transition Conventional

3. Segregation of organic and non-organic products: N/A Are organic crops visually distinct from conventional and transitional crops? Yes No Please briefly describe your conversion plan:

Briefly describe the measures taken for the segregation of conventional and organic harvests :

4. Presence of buffer zones Yes No N/A What do you do with your buffer zone harvest?

Please describe any surrounding areas with a high risk of contamination:

5. Seeds and small plants Did you use organic seed? Yes No N/A If not, why? :

If you have used non-organic seed please provide the following documents: Two documents proving the non-availability of the desired variety in organic Proof that the seed was not treated with prohibited inputs. Guarantee of non GMO (GMO crop varieties only) Please have these documents available for inspection. Are GMO seeds used in conventional fields? Yes No N/A

6. Pest and weed control Methods used:

Products used (attention to the specific requirements of foreign regulations):

7. Maintenance of soil fertility Crop rotation description:

Agricultural practices used to maintain fertility:

Farming techniques and machinery used:

What are the risks of erosion and corrective actions taken:

8. Inputs and fertilisers 8.1 Use of manure From the farm Imported Commercial When importing manure, are the following criteria met: Livestock can move 360° Livestock are not constantly in the dark. The company who produces the manure owns agricultural land Please have these documents available for inspection. 8.2 Other inputs used (fertilizers, pesticides, etc…): Name of the input Supplier Reason of use

9. Please describe water sources and measures taken to prevent pollution :

10. Do you have a greenhouse production to be certified this year Yes No Number of greenhouses in operation this year: Number or Type of Area (indicate m² Transplant or seeding Harvest date reference vegetables or of ft²) date fruits

11. Do you have Sprouts production to be certified this year Yes No Name of Product Estimated Quantity

Livestock production plan 2012 (If not applicable, please go to page 8 for signature) 1. Production Livestock type Livestock Status Number of animals

Dairy cows Org In transition Conventional Beef cattle Org In transition Conventional Sheep Org In transition Conventional Goats Org In transition Conventional Chickens (broilers) Org In transition Conventional Layers Org In transition Conventional Others : Org In transition Conventional

2. Livestock have access to the outdoors Yes No Area of pasture or exercise runs (ha or acres) : During the winter period, the animals exercise at least once every two Yes No weeks

3. The livestock I am requesting certification for were born on the farm were purchased off-farm Were the livestock purchased off-farm certified organic? If yes, you must have the certificates on hand for the inspection Yes No N/A

Chicks purchased off-farm are no more than one day old Yes No N/A

4. Is the animal feed 100% organic? Yes No Describe briefly your animal feed ration including supplements:

Ruminants are fed at least 60% hay/pasture/silage Yes No N/A Animal bedding is free of prohibited substances Yes No N/A Please have supporting documents available for inspection.

5. Herd Health Care Dairy and breeding livestock receive less than 2 antibiotic Yes No N/A treatments per year During the withdrawal period what do you do with the milk?

Animals for meat production receive less than 2 parasite control Yes No N/A treatments per year Is all health care information recorded? Yes No N/A You must have supporting documents available for inspection. Other health care products used:

6. Reproduction Are hormones used to synchronize estrus and / or is Yes No N/A artificial insemination used? What is the origin of your replacement livestock& (outside purchase, from the farm)

7. Describe the measures taken to assure the well being of your herd: On-farm :

During transport :

8. Are buildings disinfected to reduce the risk of Yes No N/A disease? Describe methods and products used for disinfection and pest management around buildings:

Production plan – On-Farm processing 2012 (If not applicable, please go to page 8 for signature) 1. On-Farm Processing Yes No Number of products : Trademark (s) :

2. Description Processing of products predominantly made with farm products (i.e.: jam, jelly, tea, cheese, etc.) - Approximate percentage of ingredients coming from your farm: % Packing of organic imported products (i.e.: essential oils, spices, etc.) Distribution of organic products from other producers (ex : distribution of grains or vegetables) Other : Description :

3. Description of the products to be certified Annual estimated Name of the products Supplier of the ingredients quantity

Signature

NOTE: For mushrooms, wild harvest, sprouting or honey production, please contact your nearest Ecocert Canada office to request the appropriate form supplement.

I hereby declare that I am aware of the certification standards which apply to my production and I authorize Ecocert Canada to contact my previous certifier to get additional information if needed.

Date Signature

NOTE: We communicate frequently with our customers via email. Thank you for notifying us of any changes to your email address at: [email protected]

Internal use Verification date : Responsable : Result transmitted to customer on :

Agricultural renewal version 01-12-2011 Page 8 of 9 Please keep this page to prepare for your inspection

Reminder of required documents to provide: Before inspection*1 (Please return the following documents with this questionnaire.) Attach an up to date detailed map showing fields in relation to one another, field numbers, surface, borders and orientation. *(if not already sent or if changes have occurred). Provide a list of all fruits, vegetables and grain products including acreage Attach a map of the facilities (Storage, packaging, processing, etc.) * Attach the completed Field History Sheet (mandatory) Road map (required upon 1st registration or modification to the site) Subcontractor’s agreement (slaughterhouse, storage or refrigerated facility etc.) Proof of registration of your farm and all trademarks During inspection*2 ( Make sure you have these documents available and up to date for inspection) Fields and / or greenhouses records Animal records (production, purchase, health….) Purchases, input technical data sheets, non GMO certificates, non-availability documents, etc. Archives going back a maximum 5 years (records, accounting…) Product label (if available at inspection time). Details of new sites: Affidavits stating the last application of prohibited inputs, field history sheet of the last 36 months and map. Proof of non-availability for organic seed varieties Proof of compliance of imported animal manure Proof of compliance for litter (if purchased outside the) Accounting Documents from PATLQ, PATBQ, ATQ, or any other control agency (milk board….) etc. (when applicable) To receive a transaction certificate (TC) Please send the following documents to the Ecocert Canada head office The produced quantities during the year (lots #) The inventories of the past year still stored The sale invoices concerned for the TC request

Agricultural renewal version 01-12-2011 Page 9 of 9