<p>Revision Date: 3/21/16</p><p>Page 1 of 10</p><p>Producer Name and Farm Name if applicable: ______</p><p>Mailing Address: ______Production site address: ______</p><p>County: ______State: ______Zip: ______</p><p>Phone: ______</p><p>Plan Start Date (Month, Year):______</p><p>1 Export Broker name, address and phone number </p><p>______</p><p>2 Integrator name ______</p><p>3 Size of houses (Number the houses on the map according to the farmer) ______</p><p>4 Size of waste storage facilities (Planned—Existing) ______</p><p>5 Number of chickens/house ______</p><p>6 When are chickens put in houses---Month and Year (Are they put in ALL houses at the same time? If not, date for each house?) ______</p><p>7 Do they cake between flocks (every flock or every other flock)? ______</p><p>Tons/house? ______Where does it go? ______</p><p>Revision Date: 3/21/16</p><p>Page 2 of 10</p><p>8 Total cleanout month ______</p><p>9 Size of Composter (Planned or existing) ______</p><p>10 Locate all wells, incinerators, burial sites, composters, dry stacks, sheds etc. on maps identify if planned or existing, sizes of existing composters etc.</p><p>11 Why are they wanting this plan—get dry stack, incinerator etc.</p><p>12 Days birds are in houses______Days between flocks______</p><p>13 Broilers______Layers______Breeders______</p><p>14 Manure tests (Date of tests) Attach</p><p>15 Soil tests—correlate to field names or numbers—write this on the attached soil test report.</p><p>16 Crops grown (with yield estimates) in each application filed by year (5 years) complete form below.</p><p>17 Tillage done before or after each crop complete form below. </p><p>18 Equipment available for emergency burial (backhoe, bulldozer etc.) ______</p><p>Revision Date: 3/21/16</p><p>Page 3 of 10</p><p>1. Soil Quality Concerns Soil Quality Concern Fields Ephemeral Gully Erosion Gully Erosion Sheet and Rill Erosion Stream/Ditch bank Erosion Wind Erosion</p><p>2. Water Quality Concerns Water Quality Concern Fields Manure Runoff (From Facilities) Nutrients in Groundwater Nutrients in Surface Water</p><p>3. Other Concerns Addressed Other Concern Fields Acres Available for Manure Application Aesthetics Neighbor Relations Profitability Regulations Time Available for Manure Application Odors Air Quality Biosecurity</p><p>Revision Date: 3/21/16</p><p>Page 4 of 10</p><p>Other Concern Fields</p><p>Revision Date: 3/21/16</p><p>Page 5 of 10</p><p>What are the animal type, number and average weight as applicable below?</p><p>Animal Type Number Ave. Weight % Confined %On Pasture Sucking Calf (beef) ______Weaned Calf (beef) ______Growing Steer (beef) ______Finishing Steer (beef) ______Brood Cow/Heifer (beef) ______</p><p>Calf Dairy ______Weaned Heifer/Steer (dairy) ______Growing Heifer/Steer (dairy) ______Breeding Heifer (dairy) ______Milk Cow (dairy) ______Dry Cow (dairy) ______</p><p>Sow and Litter ______Nursery Pig ______Grow-Finish Pig ______Wean-to-Finish Pig ______Gestating Sow ______Boar ______Sheep ______Chickens (Broilers)** ______Chickens (Pullets)** ______Chickens (Layers) ______Turkey ______</p><p>** Note if any houses are gender specific</p><p>Revision Date: 3/21/16</p><p>Page 6 of 10</p><p>Revision Date: 3/21/16</p><p>Page 7 of 10</p><p>4. What kind of dead animal disposal (normal mortality)do you use (circle all that apply)</p><p>Burying Composting Pick-Up Incineration Landfill </p><p>Other: ______</p><p>5. If composting, is compost material applied to any fields (Y/N) If so, which </p><p> fields______</p><p>6. Who does the rendering of landfill (Contact information)? ______</p><p>7. What kind of manure spreader(s) do you use? ______</p><p>Beater spreader: ______Spread Width/Field: ______Capacity (tons): ______8. Do you have manure tests of type of manure in last three years? Separate test needed for EACH storage facility (Y/N) 9. Is manure stored at fields for extended periods? If so, how long? ______10. What are your farm livestock facility needs or planned structures?</p><p>______</p><p>______</p><p>Measure All chemicals are stored in proper containers. Expired chemicals and empty containers are properly disposed of in accordance with state and federal regulations. Pesticides and associated refuse are disposed of in accordance with the FIFRA label.</p><p>Chemical storage areas are self-contained with no drains or other pathways that will allow spilled chemicals to exit the storage area.</p><p>Revision Date: 3/21/16</p><p>Page 8 of 10</p><p>Measure Chemical storage areas are covered to prevent chemical contact with rain or snow.</p><p>Emergency procedures and equipment are in place to contain and clean up chemical spills. Chemical handling and equipment wash areas are designed and constructed to prevent contamination of surface waters, wastewater, storm water storage and treatment systems. All chemicals are custom applied and no chemicals are stored at the operation. Equipment wash areas are designed and constructed to prevent contamination of surface waters, wastewater, storm water storage and treatment systems.</p><p>Revision Date: 3/21/16</p><p>Page 9 of 10</p><p>Field Soil Test Year 1 Year 1 Year 1 Year 2 Year 2 Year 3 Year 3 Year 4 Year 5 Year 6 Name Lab. Tillage Crop/ Tillage Crop/ Tillage Crop/ Tillage Crop/ Tillage Crop/ Number prior to Yield prior to Yield prior to Yield prior to Yield prior to Yield Planting Planting Planting Planting Planting</p><p>Revision Date: 3/21/16</p><p>Page 10 of 10</p><p>I certify that all field boundaries, property boundaries, well locations, animal information, and crop information listed above is accurate to my operation at the time of the field visit. I understand that the CNMP/NMP will be developed using the information provided above. It is my responsibility to inform Praedium of any changes to my operation. </p><p>The information given was provided by ______during the field visit on ______. (CNMP/NMP Client)</p><p>______CNMP Client Date</p><p>______Praedium Planner Date</p><p>ADDITIONAL NOTES:</p>