Fill and Sign the C019 Physiotherapy Services Invoice Wcb Alberta Form

IDAHO DEPARTMENT OF AGRICULTURE BUREAU OF DAIRYING PO BOX 790 BOISE ID 83701-0790 (208) 332-8550 DAIRY AMMONIA REGISTRATION FORM IDAPA 58.01.01.763 IDAHO DEPARTMENT OF ENVIRONMENTAL QUALITY 1410 NORTH HILTON BOISE ID 83706 (208) 373-0502 DEQ Form #AQ-F-P019 (5-30-06) DAIRY NAME: _________________________ DATE: __________________________ OWNER NAME: _________________________ STREET ADDRESS: _____________________________ CITY: ____________________ MAILING ADDRESS (if different from Street Address): ______________________________________ CITY: ____________________ TELEPHONE: ________________________ NUMBER OF COWS __________ OR ANIMAL UNITS: _____________ WHAT PERCENTAGE OF YOUR FARM IS: DRYLOT ____ FREESTALL/SCRAPE ____ FREESTALL/FLUSH ____ Ammonia Control Effectiveness 1 BMP Employed System/ Component Open Lot Freestall Scrape Freestall Flush Compliance Method3 BMP Points Mark below the BMPs you employ to total 27 points (For an explanation of BMPs, see the Fact Sheet at http://www.deq.idaho.gov/air/permits_forms/permitting/pbr_dairies.cfm). 1. Waste Storage and Treatment a b c d e f g h i j k l m n Synthetic Lagoon Cover GeoteXtile Covers Solids Separation Composting Separate Slurry and Liquid Manure Basins In-House Separation Direct Utilization of Collected Slurry Direct Utilization of Parlor Wastewater Direct Utilization of Flush Water Aerated Lagoon Sequencing-Batch Reactor Zeolite Addition to Liquid Manure Lagoon Nitrification/Denitrification Systems Fixed-Media Aeration Systems a b Vegetative or Wooded Buffers (established) Vegetative or Wooded Buffers (establishing) 2.  15 10 3 4 6 0 6 10 8 10 15 4 15 15 20 13 3 4 10 12 10 10 0 12 20 5 20 20 20 13 3 4 0 10 13 15 20 6 20 20 1 1 3, 4 1 1 1 1, 3, 4 1 3, 4 2 2 2 2 2 7 2 7 2 7 2 1 1 UD - 3 UD 10 10 3 UD 10 10 1 1 3, 4 4 4 10 4 10 2 2 5 2 5 2 2 5 2 5 1, 2 1 2 1 1 2 2 2 2 12 12 10 6 10 12 8 8 7.5 4.5 7.5 8 6 6 5 3 5 6 2 2 2 1 1 1 10 10 5 10 7 5 8 10 15 10 5 10 7 8 8 10 7.5 10 5 15 10 8 10 12 2 2 2 3, 4 1 1, 2 1 1 General Practices 3. Freestall Barns a b c d Scrape Built Up Manure Frequent Manure Removal Tunnel Ventilation w/Biofilters Tunnel Ventilation w/Washing wall a b c d e Rapid Manure Removal Corral Harrowing Surface Amendments In-Corral Composting / Stockpiling Summertime Deep Bedding 4. Open Lots and Corrals 5. Animal Nutrition a 6. Manage Dietary Protein Composting Practices a b c d e f Alum Incorporation Zeolite Incorporation Carbon:Nitrogen Ratio (C:N) Ratio Manipulation Composting Static Pile Forced Aeration Composting Forced Aeration Composting w/ Biofilter  Land Application2 7. a b c d e f g h Soil Injection - Slurry Incorporation of manure within 24 hrs Incorporation of manure within 48 hrs Nitrification of lagoon effluent Low Energy/Pressure Application Systems Freshwater Dilution Pivot Drag Hoses Subsurface Drip Irrigation Producer must have at least 27 points for compliance Notes: 1. 2. 3. BMP TOTAL The ammonia emission reduction effectiveness of each practice is rated numerically based on practical year-round implementation. Variations due to seasonal practices and expected weather conditions have been factored into these ratings. Not implementing a BMP when it is not practicable to do so, does not reduce the point value assigned to the BMP, nor does it constitute failure to perform the BMP. UD indicates that the practice is still under development. Land application practices assume practice is conducted on all manure; points will be pro-rated to reflect actual waste treatment; points can be obtained on exported material with sufficient documentation. Method used by inspector to determine compliance: 1. = Observation by Inspector 2. = On-Site Recordkeeping Required 3, 4 = Deviation Reporting Required. Equipment upsets and/or breakdowns shall be recorded in a deviation log and if repaired in a reasonable timeframe does not constitute non-compliance with this rule. I certify that the statements and information contained herein are true, accurate and complete to the best of my knowledge and belief. Producer Signature Within thirty (30) days receipt of this registration, the state of Idaho will conduct a qualifying inspection to ensure the requisite point total of BMPs are employed. Instructions: Note: Two copies of this form are required. Send one copy of completed form to ISDA and one copy of completed form to DEQ at the following addresses: Idaho State Department of Agriculture Bureau of Dairying Attn: Marv Patten P. O. Box 790 Boise, ID 83701-0790 Idaho Department of Environmental Quality Stationary Source Program Attn: Mike Simon 1410 N. Hilton Boise, ID 83706 1. Provide identifying information (dairy name, owner, address, city). 2. Fill in date form is submitted. 3. Provide information on number of cows or animal units. 4. Indicate what percentage of your farm is drylot, freestall/scrape, and/or freestall/flush. 5. Check BMPs employed and indicate corresponding points attained for each. A total of 27 points are required for compliance. 6. Sign form. 7. Send completed form to ISDA and DEQ at addresses listed above. Questions? Contact Mike Simon, Idaho Department of Environmental Quality, at (208) 373-0502 or michael.simon@deq.idaho.gov.