<p> Approved Form Environmental Protection Act 1994</p><p>Agricultural Environmentally Relevant Activities – agricultural chemicals, fertilisers and soil conditioners application</p><p>The purpose of this form is to keep records for agricultural environmentally relevant activities (ERAs) in relation to agricultural chemicals, fertilisers and soil conditioners applied on agricultural properties in the Great Barrier Reef catchments: Wet Tropics, Burdekin Dry Tropics and Mackay Whitsundays catchments, under the Environmental Protection Act 1994 (the EP Act).</p><p>This approved form should be used to record the information below within 10 business days after undertaking the activity/event. References to the Environmental Protection Regulation 2008 (the EP Reg) are also made within this approved form. It is a requirement of the EP Act that this record be kept for at least five years, and be produced to an officer of the Department of Environment and Heritage Protection if requested.</p><p>Note: if records are kept in another manner that meets all the requirements of this approved form, you do not need to complete this approved form, and those records will be deemed to be an agricultural ERA record. However, all other record keeping requirements must be met, including the requirements to make the record within 10 business days after the activity/event has occurred, and to keep the record for at least five years.</p><p>Part 1: Property and contact details</p><p>Person responsible for the <INSERT Name> agricultural ERA</p><p>Company name (if applicable) <INSERT Name> </p><p>Property address <INSERT Address> </p><p>Postal address <INSERT Address></p><p>Farm identification number (if <INSERT Farm identification number> applicable)</p><p>Name of person making record <INSERT Name></p><p>Date of record <INSERT Date></p><p>Part 2: Records for agricultural chemicals, fertilisers and soil conditioners application (Section 83(2)(a) of the EP Act)</p><p>Product trade name Method of application (Section 22F(b) of the EP Reg) Date of application</p><p><INSERT Name> <INSERT Date> fertigation </p><p>Page 1 of 7 • ESR/2016/2525 • Version 2.00 • Effective: 21 07 2016 ABN 46 640 294 485 Approved Form Agricultural Environmentally Relevant Activities – agricultural chemicals, fertilisers and soil conditioners application surface – broadcast</p><p> surface – banded </p><p> sub – surface </p><p> surface – broadcast and incorporated</p><p> surface – banded and incorporated</p><p> aerial</p><p> over canopy</p><p> under canopy/directed spray</p><p> shielded/hooded sprayer</p><p> spot spray application</p><p> band spraying</p><p><INSERT Name> <INSERT Name> <INSERT Date> fertigation </p><p> surface – broadcast</p><p> surface – banded </p><p> sub – surface </p><p> surface – broadcast and incorporated</p><p> surface – banded and incorporated</p><p> aerial</p><p> over canopy</p><p> under canopy/directed spray</p><p> shielded/hooded sprayer</p><p> spot spray application</p><p> band spraying</p><p><INSERT Name> <INSERT Name> <INSERT Date> fertigation </p><p> surface – broadcast</p><p> surface – banded </p><p>Page 2 of 7 • ESR/2016/2525 • Version 2.00 • Effective: 21 07 2016 Department of Environment and Heritage Protection Approved Form Agricultural Environmentally Relevant Activities – agricultural chemicals, fertilisers and soil conditioners application sub – surface </p><p> surface – broadcast and incorporated</p><p> surface – banded and incorporated</p><p> aerial</p><p> over canopy</p><p> under canopy/directed spray</p><p> shielded/hooded sprayer</p><p> spot spray application</p><p> band spraying</p><p><INSERT Name> <INSERT Name> <INSERT Date> fertigation </p><p> surface – broadcast</p><p> surface – banded </p><p> sub – surface </p><p> surface – broadcast and incorporated</p><p> surface – banded and incorporated</p><p> aerial</p><p> over canopy</p><p> under canopy/directed spray</p><p> shielded/hooded sprayer</p><p> spot spray application</p><p> band spraying</p><p><INSERT Name> <INSERT Name> <INSERT Date> fertigation </p><p> surface – broadcast</p><p> surface – banded </p><p> sub – surface </p><p> surface – broadcast and incorporated</p><p>Page 3 of 7 • ESR/2016/2525 • Version 2.00 • Effective: 21 07 2016 Department of Environment and Heritage Protection Approved Form Agricultural Environmentally Relevant Activities – agricultural chemicals, fertilisers and soil conditioners application surface – banded and incorporated</p><p> aerial</p><p> over canopy</p><p> under canopy/directed spray</p><p> shielded/hooded sprayer</p><p> spot spray application</p><p> band spraying</p><p><INSERT Name> <INSERT Name> <INSERT Date> fertigation </p><p> surface – broadcast</p><p> surface – banded </p><p> sub – surface </p><p> surface – broadcast and incorporated</p><p> surface – banded and incorporated</p><p> aerial</p><p> over canopy</p><p> under canopy/directed spray</p><p> shielded/hooded sprayer</p><p> spot spray application</p><p> band spraying</p><p><INSERT Name> <INSERT Name> <INSERT Date> fertigation </p><p> surface – broadcast</p><p> surface – banded </p><p> sub – surface </p><p> surface – broadcast and incorporated</p><p> surface – banded and incorporated</p><p> aerial</p><p>Page 4 of 7 • ESR/2016/2525 • Version 2.00 • Effective: 21 07 2016 Department of Environment and Heritage Protection Approved Form Agricultural Environmentally Relevant Activities – agricultural chemicals, fertilisers and soil conditioners application over canopy</p><p> under canopy/directed spray</p><p> shielded/hooded sprayer</p><p> spot spray application</p><p> band spraying</p><p><INSERT Name> If you need to list additional products, please attach a list to this approved form, providing the same information as above. </p><p>Part 3: Calculation of optimum amounts (Section 83(2)(c) of the EP Act)</p><p>Calculated optimum rate of <INSERT Name> <INSERT nitrogen (N) (kg/ha) Date> (Section 80(1) of the EP Act)</p><p>Calculated optimum rate of <INSERT Name> <INSERT phosphorus (P) (kg/ha) Date> (Section 80(1) of the EP Act)</p><p>Part 4: Soil test reports (Section 83(2)(b) of the EP Act)</p><p>Name of person conducting <INSERT Name> <INSERT test and their relevant Date> experience or qualification (Section 81(2) of the EP Act)</p><p>Characteristics of the soil <INSERT Name> (description) (Section 81(1)(a) of the EP Act)</p><p>Part 5: Property boundaries (Section 22F of the EP Reg)</p><p>Please describe the boundaries of the following as maps or diagrams of the relevant agricultural property: (Note: maps or diagrams may be included in the space below, or attached to this approved form) 1. Crops or paddocks from which soil has been taken for testing; and</p><p>2. The areas to which fertilisers or soil conditioners have been applied.</p><p>Page 5 of 7 • ESR/2016/2525 • Version 2.00 • Effective: 21 07 2016 Department of Environment and Heritage Protection Approved Form Agricultural Environmentally Relevant Activities – agricultural chemicals, fertilisers and soil conditioners application</p><p>Page 6 of 7 • ESR/2016/2525 • Version 2.00 • Effective: 21 07 2016 Department of Environment and Heritage Protection Approved Form Agricultural Environmentally Relevant Activities – agricultural chemicals, fertilisers and soil conditioners application</p><p>Page 7 of 7 • ESR/2016/2525 • Version 2.00 • Effective: 21 07 2016 Department of Environment and Heritage Protection</p>