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"" $"  `q InstructionsApplication Pages 1 Page 2HAttachment Page 3vShipping Form Page 4NMP Summary Page 5>Ave. Analysis Optional " Counties;  County;  ;$  ;U   ;4Trj0t3 A@@   E}"MARYLAND DEPARTMENT OF AGRICULTUREMANURE TRANSPORT PROJECT (APPLICATION/AGREEMENT - LAND APPLICATIONAGREEMENT NUMBERMT For MDA Use SS / FID #DistrictTelephone NumberSNAME and ADDRESS of person to receive check, include farm / corporate name, if any.Sender Receiver AMOUNTUNITTonsYd3Yd3 < 25 MilesMILEAGETRANSPORT FROMAll Other Areas DO,SO,WI,WO DO,SO,WI,WO PAYMENT RATE $0.12/Ton/mile $0.04/Yd3/mile $0.15/Ton/mile $0.05/Yd3/mileTOTAL!Poultry Litter Testing / AnalysisRATE $0.20/Ton $0.0667/Yd3Poultry Litter Loading $1.50/Ton $0.50/Yd3Authorized Signature Date!(Designated Chairman or Designee) SECTION IV - APPLICANT AGREEMENTPublic Information Notice: The principal purpose for which the information on this application is used is to identify you as one of those persons whom the agency intends to give State Cost-Share funds. If you fail to provide the requested information, the agency may not provide you with State Cost-Share funds. You have a right to inspect, amend, or correct personal information collected by the agency. Much of the personal information collected by the agency is available for public inspection. =CERTIFICATION: I request cost-sharing under this program to solve a nutrient management/water quality problem. I have read and agree to adhere to requirements set forth under (1) COMAR 15.20.05 and (2) this agreement which includes the Attachment. I understand that I shall not proceed with this project until I have received a letter of approval and a signed and dated copy of my agreement from the Maryland Department of Agriculture. If I fail to comply with the requirements set forth under COMAR 15.20.05 and this agreement, the Department with no obligation to pay the applicant can cancel the agreement and any payments already made will be forfeited. I agree that the Soil Conservation District, its officers, agents, and employees are not responsible for any damage to life and property due to my activities, or those of my operation s officers, agents and employees, in connection with this Agreement. Furthermore, I agree the Soil Conservation District shall be held harmless by me from any liability resulting from the removal, transportation, or use of animal waste.Signature of Applicant>Total Estimate of Cost - Share (transport, analysis, loading):Cost Effectiveness:JClean-out scheduled date or approxmite dates manure will be transported: toManure Generated/Stored Tons/Gallons)Manure Used in a Nutrient Management PlanManure Eligible for TransportHouse # Length (feet) Width (feet)Average Depth (feet) Factor lbs/cu foot (25 - 35)#1#2#3#4#5#6Shed #1Shed #2 TOTAL TONSGeneral Comments:'SECTION V - DETERMINATION OF ELIGIBILTYThe Maryland Department of Agriculture has determined that this application is (is not) eligible for state cost sharing for the estimated amount shown at the right. If not, it is explained in General CommentsSignature (MDA Representative)MDA Estimate of Cost Shares: $SECTION VI - FUND INFORMATIONThe Maryland Department of Agriculture certifies that the agreement for this project is in order, is signed by all parties and is approved.Fund Source(s):Approval Amount X General Federal  $ SECTION VII - AGREEMENT APPROVALThe parities have executed this Application/Agreement, by causing the same to be signed on the day and year first written above.)By: _____________________________________STATE OF MARYLANDDEPARTMENT OF AGRICULTURE,SUPPLEMENTAL INFORMATION - SENDING OPERATIONThe Applicant agrees:qTo have the poultry litter analyzed for nutrient content as directed by the Department before it is transported.cTo comply with all Department biosecurity and public safety requirements, including the following:<I have read the above provisions and shall comply with them.1)2)3)4)5)6)7)8)9)Cd. Compliance with all Departmental animal health requirements; andTo allow a MDA representative(s) access to the receiving and/or sending site(s) for the purpose of inspection and verification of program compliance.bIf poultry litter is being transported less than 7 miles from a production or storage site to the applicants farm that: (1) the litter is being transported to a farm not owned or managed by the producer; (2) the land receiving the litter is not phosphorus over enriched; and (3) the applicant will apply the litter according to program requirements. Ia. All poultry litter shall be covered while on a public road or highway;b. A truck-mounted or tractor-drawn spreader shall be covered during the transportation of litter from one farm to another unless contiguous;c.Prior to operating on or near another poultry operation, all transporting and handling equipment used to transport litter shall be cleaned, washed, and disinfected;e.If hiring another person to transport litter, requiring that person to comply with biosecurity and public safety requirements.To apply manure as a source of plant nutrients according to a state certified nutrient management plan under the following conditions:MANURE TRANSPORT PROJECT"ATTACHMENT TO COST-SHARE AGREEMENT$ MARYLAND DEPARTMENT OF AGRICULTURE' AGREEMENT NO. _____________________MT#MARYLAND DEPARTMENT OF AGRICULTURE MANURE TRANSPORTATION PROJECTAPPLICANT ADDRESS:CITY/STATE/ZIP:PHONE:CONTACT:NMP CONSULT NAME: FARM NAME:CONSULTANT CERTIFICATION NO#:COUNTY:RECEIVING LOCATION ADDRESS: CITY/STATE/ZIP: TOTAL TONS SHEET # APPLICANTS NAME:RECEIVING LOCATION:SENDING OPERATION (1) NAME:NAME/FARM NAME:CLAND APPLICATION SHIPPING FORM (101) - TO BE COMPLETED BY APPLICANTTo provide a delivery site for the off-loading of litter that is safe and does not pose any undue environmental risk to water quality. (See Delivery Site Guidelines)Either the producer or the receiver of poultry litter, but not both, is eligible to apply for and receive state cost-share assistance. A producer may only apply under a pooling agreement. (See Poultry Producer Guidelines)ACCOUNT ID No. ** : SECTION 1 - APPLICATION (101)a. For fields with soil testing less than 101 for phosphorus on the Fertility Index Value, poultry litter may be used according to a nitrogen-based nutrient management plan;b. For fields with soil testing optimum, or 101 to 150 for phosphorus on the Fertility Index Value, poultry litter shall be applied according to a nutrient management plan using phosphorus as the limiting factor. 1PROVISIONS FOR LAND APPLICATION OF POULTRY LITTERTo apply poultry litter within 7 days of its receipt according to a nutrient management plan or stockpile or store litter in a manner that protects it from rainfall, runoff or leaching. (See Stockpiling Guidelines)If the poultry litter is stockpiled or stored for 6 months or greater, to perform an a< dditional nutrient analysis for litter as close as possible to the plant nutrient application period as provided in a nutrient management plan.c. Fields with soil testing 150 or greater for phosphorus on the Fertility Index Value are not eligible and a person shall not apply pouiltry litter. Name: Address:City/State/Zip:TONS/YARDS (NMP):e __________________________________ Signature ________ Date Page 4 of 4( X )( )Allen'sPerdue MountaireTyson Worcester>LAND APPLICATION WORKSHEET - RECEIVING OPERATION - NMP SUMMARYRECEIVING FIELDS Account ID #Field #AcresCrop Yield Goal Telephone: Page 5 of 5Allegany Anne ArundelBaltimore CountyCalvertCarolineCarrollCatoctinCecilCharles Dorchester FrederickGarrettHarfordHoward MontgomeryPrince George's Queen Anne's St. Mary'sSomersetTalbotWashington CountyWicomicoKentCornWheatHayPastureOatsBarley TOTAL Tons TOTAL AcresOriginal Used (attached)Poultry Company:Averaged Analysis UsedManure Analysis:Perdue Average AnalysisAllen's Average AnalysisMountaire Average AnalysisTyson Average Analysis Signature - Receiving OperationPOULTRY LITTER (101) Tons Yards<ATTACHMENT TO THE APPLICATION/AGREEMENT OR POOLING AGREEMENTNO. ______________________ MT<PROVISIONS FOR: INTERIM NUTRIENT MANAGEMENT PLAN DEVELOPMENTThe Nutrient Management Plan required for eligibility for the Manure Transportation Project (Project) has been written using an estimated average for the manure analysis associated with Commercial Poultry Producers and approved by the Department for interim plan development.The projected manure analysis: NutrientsPerdue Average#Allen s, Mountaire, Tyson - AverageTotal Nitrogen 3.0 percentNH4 .3 percent Phosphorus 2.5 percent PotassiumThe estimated average for the manure analysis shall only be used: (1) when the moisture content is between 20 and 35 percent; (2) after a minimum of five flock cycles have taken place; and (3) shall only be associated with a clean out, or clean out which includes removal of poultry litter from a storage structure. Do not use this analysis when only transporting manure from a manure storage shed.\As a condition to participating in the Project, the applicant and receiving operation agree:O1) To adjust and apply, as necessary, the rate of poultry litter based on the actual manure analysis I receive from the poultry litter producer with the shipment of manure transported under this Project. Application rates are based on University of Maryland recommendations standards contained in the nutrient management regulations;2) To update the nutrient management plan should the actual manure analysis indicate a difference of .5 (one half) ton per acre or greater in the application rate from the contained in the interim nutrient management plan;3) To sign and return a copy of the analysis for the manure received from the poultry litter producer to be submitted with the Applicant s  Claim for Payment; and4) To allow Department representatives to verify modification(s) made to application rates using actual manure analysis during subsequent spot-checks.OThe applicant understands, that due to differences between the estimated average manure analysis used to develop the nutrient management plan and the actual manure analysis received, that any change in application rate will not change the amount of manure approved as eligible for cost share for transportation costs under the Project."#________________________ ________________________________ APPLICANTDATERECEIVING OPERATION%Poultry Litter Calculation (optional) Stockpiling SpringSummerFallApplication Period:SorghumSoil Test Lab #Certification Number#Nutrient Management Consultant NameConsultant Telephone Plan Date District:BName of Poultry Company Under Contract (only one per application): JULY 2007MDA - 101 - APPL REV 7/2007 Page 1 of 5 Page 2 of 5Claim Information: Chain Of Custody Form # (Account Id Number(s) on this form must match Acount Id Number(s) on on Chain of Custody Form.+Enter Chain of Custody Form # - Claim StageGrassMRECEIVING FARMS (NUTRIENT MANAGEMENT PLANS REQUIRED/SUMMARY ATTACHED) G Page 6 of 61Manure Transport Project Application InstructionsPoultry Litter Only (101)!A) SECTION I (Page 1) - REQUIRED  A1) Complete/enter - Social Security Number or Federal ID Number.=2) Complete/enter - Soil Conservation District (county) (*).:3) Complete/enter - Telephone Number. Include area code.[4) Complete/enter - Name, Address, City, State, and Zip. After "Name" may include company&name or farm name. See example below.$5) Indicate Sender or Receiver (*)."B) SECTION II (Page 1) - REQUIRED  a1) Complete/enter - Amount of poultry litter to be transported. Select appropriate unit that isaconsistent with units in the nutrient management plan for the receiving operation. Also consider]the location of the sending operation. Poultry litter transported from Dorchester, Somerset,NWicomico and Worcester counties (DO, SO, WI, WO) has a different payment rate.I2) Complete/enter - Mileage, estimate mileage to the nearest whole mile.]3) Complete/enter - Amount for Poultry Litter Testing/Analysis (optional). Must be the same:amount and select the same unit that is being transported._4) Complete/enter - Poultry Litter Loading (optional). Must be the same amount and select the$same unit that is being transported.5) Print, sign and submit.R1) Space has been provided for poultry house clean out dates and transport dates.Z2) Space has been provided to indicate the manure generated by the sending operation, theVmanure used in a NMP, and the amount of manure eligible for transport. Providing this\3) Poultry Litter Calculator (optional) - Use of this tool provides an applicant a means toEdetermine the amount of litter that might be available for transport.&4) Print and submit with Application.General Instructions -K2) For your convenience drop down boxes are provided in certain cells (*).13) After completing print out pages 1 through 5.Man interim nutrient management plan for the receiving operation was developedusing and average analysis.J5) Submit completed Application / Agreement to the Maryland Department of5Agriculture or your local Soil Conservation District.Name::D) ATTACHMENT TO COST-SHARE AGREEMENT (Page 3) - REQUIRED / 1) Print out attachment.spaces provided.3) Sign and submit Attachment.IC) SUPPLEMENTAL INFORMATION and APPLICANTS COMMENTS, (Page 2) - OPTIONAL > %E) SHIPPING FORM (Page 4) - REQUIRED  +1) Complete/enter Applicant's information.^2) Complete/enter Sending Operation information. Only one sending operation per Application.]3) Complete/enter Receiving Farms. Provide property account identification numbers for eachU4) Complete/enter amount of poultry litter (tons/yards) to be received at each farm.[F) NUTRIENT MANAGEMENT PLAN SUMMARY - RECEIVING FARM - (In lieu of the Nutrient Management 5 8'NPlan being submitted, this Nutrient Management Plan Summary may be submitted.)B1) Complete/enter - Name, Address, City, State, Zip and Telephone/2) Complete/enter - Farm Name (Receiving Farm)a3) Complete/enter Nutrient Management Plan Consultant Name, Certification Number, and Plan date.H4) Indicate - Average Analysis Used or Original Analysis Used (attach). 5) Indicate if Stockpiling ([).(H6) Complete/Select - Poultry Company contracted with sending operation.B7) Complete/Select - Application Period, Spring, Summer, or Fall.`8) Complete/enter - Account ID Number (*), Field <^Number, Soil Test Lab Number, Acres, Crop (*),$Yield Goal, and Rate of Application.9) Print, Sign, and submit.M10) Attach soil analysis and maps for those fields receiving poultry litter. NG) INTERIM NUTRIENT MANAGEMENT PLAN DEVELOPMENT - OPTIONAL - Average Analysis 0 #1) Review, Print, Sign and submit.MAIL COMPLETED APPLICATION TO:"Maryland Department of Agriculture@Maryland Agricultural Cost-Share - Manure Transportation Project50 Harry S. Truman ParkwayAnnapolis, MD 214011FOR QUESTIONS AND ADDITIONAL INFORMATION CONTACT:"Norman Astle - Project Coordinator 410-841-5863!MDA Website: www.mda.state.md.usZ6) Complete/enter Commercial Poultry Company (integrator). (*) Only one per application.Pinformation will assist in determining the eligibility of the sensing operation.3John W. Smith Doe Hill Farm11 East West RoadAnytown, MD 99999Balance Forward (page 5)TOTAL Tons (page 5)Acres (page 5)MTP - www.mda.state.md.usPAGE 1PAGE 4PAGE 6PAGE 5 ?SECTION II - TECHNICAL REPORT - POULTRY LITTER TRANSPORTATION Total Tons X $18.00Applicant's Comments:(AGREEMENT No. ____________________ MT POULTRY CO. CONTRACT WITH:Q* Account ID No. for the actual parcel of land producing or receiving the manure.ACCOUNT ID No. * : Page 3 of 4 State Cert. #3Name of Nutrient Managment Plan preparer (sending):5Name of Nutrient Managment Plan preparer (receiving):a2) Complete/enter name(s) of Nutrient Management Plan preparer(s) and Certification Number(s) inYTons (Length X width X depth X lbs per cu. Ft./2000 lbs)&zPOULTRY LITTER (101) ADDITIONAL WORKSHEET - USE AS NEEDEDm* Rate of Application (tons/acre)/Amount acres x (tons/acre) TOTAL Cubic Yds (TOTAL Tons x 3)"Use Additional Worksheet As NeededCertification: Soil analyses and maps for fields listed above and on additional worksheets are attached. This is not a Nutrient Management Plan. The above and attached information comes from my Nutrient Management plan using recommendations for poultry litter as a nutrient source. The plan is on file at my place of business and I understand it may have to be submitted prior to Agreement approval. As indicated above, the manure analysis used to develop the plan is attached unless an average analysis is used. If not provided I understand a litter analysis is required to be taken prior to transporting the poultry litter and submitted with my claim for payment. ivCertification: Soil analyses and maps for fields listed above are attached. This is not a Nutrient Management Plan. The above information comes from my Nutrient Management plan using recommendations for poultry litter as a nutrient source. The plan is on file at my place of business and I understand it may have to be submitted prior to Agreement approval. As indicated above, the manure analysis used to develop the plan is attached unless an average analysis is used. If not provided I understand a litter analysis is required to be taken prior to transporting the poultry litter and submitted with my claim for payment. M Washington Baltimore Instructions Continued$Use of this Application/Agreement - D) Completion of this Application Agreement may require the assistance of a nutrient management consultant and/or assistance from the local soil conservation district.mA) This Application/Agreement is for the transport of poultry litter under the Manure Transporation Project. oB) This Application /Agreement can only be used by an operation receiving poultry litter for land application. C) The poultry litter transported must be produced by a poultry grower under contract with a Commercial Poultry Producer (Allen's, Mountaire, Perdue, Tyson).Document Addressahttp://www.mda.state.md.us/resource_conservation/financial_assistance/manure_management/index.phpMDA - 101 - APPL REV 8/2007MDA - 101 - APPL REV 8/2007 SEPT 2007SEPT 2007 MTP - www.mda.state.md.us PAGE 3khttp://www.mda.state.md.us/resource_conservation/financial_assistance/manure_management/index.php PAGE 2 Name - Receiving Operator(s): 2 SECTION III - TECHNICAL DETERMINATION/The Maryland Department of Agriculture, or, the9Soil Conservation District has reviewed this referral andfinds it / does not find it adequate and appropriate for this program. If not, see explanation under General Comments. No determinations have been made about the appropriateness of receiving sites not within the State or District jurisdictions. Manure Analysis():3N4) Applicant's signature is required on page 1, page 3, page 5, and page 6 if`parcel of land receiving poultry litter. These acccount ID #s must match NMP and NMP Summary #s._______ OF ______1) Applicant will complete green shaded cells of Application / Agreement. (Blue shaded cells are linked to other cells in the application and will fill in automatically.)J1K21I IvJQJjKELaW<XQX,aZ<[}(]]l0dEXCEL.EXEC:\Program Files\Microsoft Office\Office10\EXCEL.EXE"cXX??cU} m }     ; ; Y@ X@ X@ X@ X@ @                       {g{{{{{{{{{ K zizzzzzzzz K zjzzzzzzzz K zkzzzzzzzz  K {h {{{{{{{{   |    H   H  yH  H  H  H I IIIIIIIJ  <f****2222>4444444 ! " # $ % & ' ( ) * + , - . / 0 1 2 345678:;<>? 3 4 5 6 7 8C :   :E: ; ;|F;|||} < <~G<~~~ > ? @RD...@ABCDEFGHJKLMNOP Q R T U V W X Z [ \ ] ^ _  @  A  B  C  D E F G H Jf K% L M N OD P Q R T! 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