NOTE: If you are using a report (updated 2/2/2009) downloaded onto your computer, please enter the appropriate information in the boxes provided. If you need more space for information, please type “See Attached” and attach a separate page.

Download the PDF of this page here.

1. Indicate Type of Report in boxes above Section 1. For the first Follow-up Report in February 2009, check box marked “Initial written notification.” Any future adjustments or amendments to the report (because of a change in operations or calculations), check the box marked, “Written notification of a change to initial notification.”

SECTION 1

2. Enter information as requested in the boxes. Under “Facility Name,” include the name of the facility, and if there is a corporate name, include that as well.

3. Physical Location can be a parcel or tract of land, or a general description of the location, such as “0.7 miles due north of intersection of County Road A and Highway B.”

4. The e-mail address is requested as a method for the State to provide timely updates to this new program.

5. Phone should be the main phone number to reach someone at the facility and Alternate Phone can be a cell phone. Please include Area Codes with the phone numbers.

6. Latitude and Longitude are optional fields. If you know this information, please enter the data. Otherwise, leave blank.

SECTION 2

7. This section requests verification that the original (phone) notification was made in accordance with US EPA’s rule. Please check the appropriate boxes and indicate the notification date. If you received a Tracking Number or Report Number from the State when you called in the original notifcation, please include that number in the box provided.

SECTION 3

8. Please indicate the appropriate box for the type of animals being reported as a Large Concentrated Animal Feeding Operation.

9. The “Additional Comments” section is for additional information or special circumstances you wish to be noted.

10. Within a 1-mile radius from the location of the Concentrated Animal Feeding Operation, indicate the Population Density and any Sensitive Populations or ecosystems. Provide the names of any schools, hospitals, retirement communities, wetlands, wildlife refuges or forests.

SECTION 4

11. Use the WORKSHEET to calculate the numbers for Section 4. DO NOT send the WORKSHEET to the SERC or the LEPC. You must maintain the Worksheet in your files.

12. Sign and Date the form. Send a copy of the FOLLOW-UP REPORT to your State Emergency Response Commission (SERC) and your Local Emergency Planning Committee (LEPC). The SERC can assist you need assistance in determining which LEPC you should send this Report to. It is recommended that you send the Report by Certified Mail -- Return Receipt Requested, or by some other verifiable means. Keep a copy of the verification with your own records.