Fill and Sign the Paid Covid 19 Leave Request Form

Idaho Department of Environmental Quality Crop Residue Burning Permit-by-Rule Registration Complete and submit this registration form at least thirty (30) days prior to your projected burn date. Submit completed burn registration form to: Idaho Department of Environmenatal Quality, CRB Program, Crop Residue Burning Registration, 1410 N. Hilton, Boise, ID 83706-1255, Fax: (208) 373-0340. All fields with an asterisk (*) are required to be filled in order to obtain a Permit-by-Rule for agricultural crop residue burning. For additional information or questions, please call the CRB Program Office at (208) 373-0332, or toll-free at 1-866-224-2456. Applicant Information / *Date: / Farm Name: *First Name: *Last Name: *Mailing Address: SUITE/APT: *CITY: *STATE: *Postal (Zip) Code: Email Address: *Home/Business Phone: ( ) - *Cell Phone or Radio Frequency: Fax: ( ) - Applicant attended State of Idaho CRB training within the last 5 years? Date Applicant Trained: / / APPLICANT'S Certification* (To be signed by the applicant) I hearby certify, based on information and belief formed after reasonable inquiry, that the statements and information contained in this and any attached document(s) are true, accurate, and complete in accorance with IDAPA 58.01.01.123-124 Name: ___________________________ Signature: ________________________ Date: ___________ (printed or typed) Page 1 of 4 9364505675 Idaho Department of Environmental Quality Crop Residue Burning Permit-by-Rule Registration Registered Field *Field Name: Legal Description *Township *Range Crop Type: *Section *1/4 Section *1/4 Section Turf Grass Cereal Grain Legumes CRP Alfalfa Corn Pasture Broken Bale Harrow Pile Blanching (i.e. mint, etc) County Other Other Crop Type: *Number of acres to be burned: *Projected Date of Burning(1): / / Estimated Burn Duration: Name of Person conducting burn (if different than applicant). *Cell Phone or Radio Frequency of person conducting burn (if different than applicant). Burner attended State of Idaho CRB Training within the last 5 years? Date Burner Trained: / / (1) IDAPA 58.01.01.618.06 requires growers to propose a date for residue burning, or determination. DEQ understands that environmental factors can influence this date to the grower to update this proposed date as the original date approaches is important needs are more adequately met. This date can be changed by notifying the CRB Program (208) 373-0332, or your local regional office. Page 2 of 4 more accurate burn call change. The ability for to ensure that growers Office in Boise at 6565505675 Idaho Department of Environmental Quality Crop Residue Burning Permit-by-Rule Registration *Fire Safety Methods: Please indicate the measures you will take to prevent escaped burns and smoke danger: water availability hand tool availability fire breaks or safety zones heavy equipment availability flaggers Other: Other2: Special Features(2) Adjacent to timber Adjacent to highway or major road Morning burn requested Special wind direction needed Contains or borders steep slopes Borders on canyon rim Within 3 miles of an institution with senstitive population Other: Other2: (2) Special feature details are considered "other relevant factors" (in accordance with IDAPA 58.01.01.621.i) that assist DEQ Agricultural Smoke Management personnel to make more accurate burn determinations. Page 3 of 4 8465505676 Idaho Department of Environmental Quality Crop Residue Burning Permit-by-Rule Registration *Plot Plan Please locate and identify in the box below: Field(s) to be burned; access roads and highways; any houses, businesses, or sensitive areas that could be impacted by the burning to be conducted. Indicate distance and direction. When more than one field is shown, label the field using the field number from page 3 of this application. Attach additional pages as needed to apply for multiple fields. A tract map, GPS map or other similar map may also be used. Page 4 of 4 8706505674