6200-09 Continuous Release Reporting for Farms

Form Approved OMB No. 2050-0086; Expires 12/31/2011

Continuous Release Reporting for Farms

ID Number
(CR-ERNS or Other)

SECTION I: GENERAL INFORMATION

Date of call to SERC/LEPC

Date of Initial Release
Type of Report: Select from drop-down list.

Signed Statement:

I certify that the hazardous substances release described herein are continuous and stable in quantity
and rate under the definition in 40 CFR 355.32 and that all submitted information is accurate and
current to the best of my knowledge.
Owner or Operator

Date

Signature
Contact Information

Part A. Farm Information
Name of Farm
Address of Farm
State

City

Zip Code

Latitude

Deg

Min

Sec

Longitude

Deg

Min

Sec

NOTE: Latitude/Longitude information can be obtained at the following websites: http://www.satsig.net/maps/lat-long-finder.htm, http://earth.google.com/,
and http://www.census.gov/geo/landview/. Do not use P.O. Box, Rural Route or Mailing Address. Use physical location only.

Part B. Population Information
Population Density:

Choose the range that describes the population
density within a one-mile radius of your farm.

Sensitive Populations or Ecosystems:

Identity and location
within one-mile radius of the farm. [check as many as apply]

Elementary
School

Hospital

Wetland

Other

Describe Distance and Direction From Facility

Retirement
Community

EPA Form 6200-09, Continuous Release Reporting for Farms

Page 1 of

INSTRUCTIONS
SECTION I: GENERAL INFORMATION
ID Number (CR-ERNS or Other):
The CR-ERNS number is not required for this submission; however, if you choose to use the CR-ERNS number as an ID number call the
National Response Center (NRC) 1-800-424-8802 and state that you are making an Initial Telephone Notification.
The Other number can be obtained from the State Emergency Response Commission (SERC) and/or Local Emergency Planning
Committee (LEPC).
The ID Number is for identification purposes only and may or may not be required by your SERC and/or LEPC.
The information required in Section I of the written report includes general information identifying your farm, as well as information regarding the area in which your farm
is located. This general information is important because it provides a better understanding of the potential risks resulting from exposure from the farm's release. A signed
statement asserting that the continuous release is continuous and stable in quantity and rate, and that the information supplied is accurate and current to the best of your
knowledge, is also required in Section I.
Section I must clearly identify the type of written report that you are submitting (i.e., a written report, or a written report of the change in source or composition of a
previously reported release). You must also include information on the initial notification of the release, such as the date of the release and the date of the initial call.
Written Notification - Within 30 days of the initial telephone notification, you are required to submit a written report to the appropriate SERC and LEPC. The purpose of
this report is to confirm your intent to report your release as a continuous release and to provide government response officials with sufficient information about your
release to enable them to determine if the release qualifies as a continuous release.
Written Notification of a Change to Initial Notification and/or Written Notification of a Change to Follow-up Report [NOTE: For these reports, select the report type that reflects the notification or report for which you are reporting a change.]
= Notification of a change in animal waste source or composition, which is treated as if it were a new release (i.e., with a telephone call to the SERC and LEPC followed
by a written report);
= Notification of a change in the normal range, if there is a change in the release such that the quantity of the release exceeds the upper bound of the reported normal
range, the release must be reported as a statistically significant increase.
Part A. Farm Information 1. The complete name of your farm (and company identifier where appropriate). If multiple farms are included in your written report, provide the farm site
name with the name of the farm.
2. The full address of your farm, including the street address or highway marker, city, county, state, and zip code. A post office box number should not be used
as the farm address. The address provided should be the location of the farm where the hazardous substance release to the air from animal waste occurs.
3. The location of your farm by its latitude and longitude in units of degrees, minutes, and seconds. See below for sources of information for identifying the
location of your farm.
4. The nine digit number assigned by Dun and Bradstreet (D&B) to your farm. This number can be obtained via telephone by an officer of your company
from the national office of Dun and Bradstreet (at 1-800-234-3867). If your farm has not been assigned a D&B number, please specify that the information
is not applicable. http://www.dnb.com/US/duns_update/
5. Be certain to include the CR-ERNS number (optional) or other identifying number on each page of your report.
6. The name, telephone number (including area code), and an alternate telephone number for the person in charge of your farm.
SOURCES OF INFORMATION FOR IDENTIFYING THE LOCATION OF YOUR FARM
Sources of data on latitude and longitude coordinates of your farm include EPA permits (e.g., NPDES permits), county property records, farm blueprints, and farm plans.
In addition, information on the latitude and longitude of your farm may be obtained from a United States Geological Survey (USGS) topographical map. These maps are
available in both the 7.5 minute and 15 minute series. These maps may be obtained from the USGS distribution center at your local public library. If you would like to
order a map from USGS, contact: U.S.Geological Survey - Information Services, Box 25286, Denver, CO 80225, call 1-888-ASK-USGS (1-888-275-8747)/http://library.
usgs.gov/maplinks.html
If you are not certain on which map your farm is located, consult the index of topographic maps for your state, which may be obtained from USGS free of charge. USGS
maps are also available at commercial dealers such as surveyors or outdoor recreation equipment dealers.
Latitude/Longitude information can be obtained at the following websites: http://www.satsig.net/maps/lat-long-finder.htm, http://earth.google.com/, and http://www.census.
gov/geo/landview/.
Part B. Population Information 1. Choose the range from the drop down list, the range that most accurately describes the population density within a one-mile radius of your farm.
2. Identify and describe the location of any sensitive populations or ecosystems within a one-mile radius of your farm. If possible, describe the location of the
populations or ecosystems in terms of distance and direction from your farm (e.g., located ¼ mile northwest of the farm). Exact addresses are not
required.
Sensitive populations - populations likely to be more susceptible than average individuals to the effects of exposure to a hazardous substance. Examples of sensitive
populations are elementary school children, retirement communities, or hospitals.
Sensitive ecosystems - environments likely to be more susceptible than average environments to the effects of exposure to a hazardous substance, or ecosystems that have
been designated for special protection by Federal or state governments. Examples of sensitive ecosystems include wetlands, wildlife refuges, tidal basins, or endangered
species habitats.