6200-15 Continuous Release Reporting Form for Farms

Date

Phone

□ Initial Written Notification □ Written Notification of a Change to Initial Notification

□ First Anniversary Follow-up Report □ Written Notification of a Change to Follow-up Report

OMB No. 2050-0086

Part A. Farm Information

Name of Farm

Location of Farm

City State Zip Code

Latitude Deg Min Sec

Longitude Deg Min Sec

Dun & Bradstreet Number

NOTE: Latitude/Longitude information can be combined at the following websites: http://www.satsig.net/maps/lat-long-finder.htm, http://earth.google.com, and http://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.

□ 0-50 persons □ 50-100 persons □ 101-500 persons □ 501- 1000 persons □ more than 1000 persons

Sensitive Populations or Ecosystems: Identity and location Describe Distance and Direction from Farm

within one-mile radius of the farm [check as many as apply]

□ Elementary School □ Hospital □ Retirement

Community

□ Wetland □ Other

Instructions

Section I: General Information

ID Number (CR-ERNS)

The CR-ERNS Number is required for this submission. NRC will assign a CR-ERNS number for your farm when you make the initial notification.

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.

Initial Written Notification - Within 30 days of the initial telephone notification, you are required to submit a written report to the appropriate EPA Regional Office.

Follow-up Written Notification (First Anniversary Report) – Within 30 days of the first anniversary date of the initial written notification, you must verify and update the information initially submitted and submit a follow-up report (even if there is no change in information) to the appropriate EPA Regional Office.

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 NRC 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.

Certification Statement – In this section, you must certify that the hazardous substances release described herein are continuous and stable in quantity and rate under the definition in 40 CFR 302.8 and that all submitted information is accurate and current to the best of your knowledge. Provide the name of owner or operator of the farm and the mailing address.

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, , 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 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

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/. Many global positioning system (GPS) navigation devices, including smart phones, can also provide latitude and longitude coordinate information. Other 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.

Latitude and longitude information of your farm may also be obtained from a United States Geological Survey (USGS) topographical map. These maps are available in the USGS distribution center at your local public library. 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. Consult the index of topographic maps for your state (available from USGS free of charge) to identify the map on which your farm is located. USGS maps are also available at commercial dealers such as surveyors or outdoor recreation equipment dealers.

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.

EPA Form 6200-15. Continuous Release Reporting for Farms Page 1 of ­­­­­­_____

File Type	application/vnd.openxmlformats-officedocument.wordprocessingml.document
Author	Mayer, Eileen
File Modified	0000-00-00
File Created	2021-01-21