Government of Ontario: Ministry of Agriculture, Food and Rural Affairs

Nutrient Management Strategy and/or Plan Sign–Off Form

1. Contact Information

Name of Farm Unit Operator

Legal Farm Name

911 Address (Street No., Street Name, RR, Lot, Concession, Township)
City/Town/Village
Province Postal Code
Telephone No. Home (incl. Area code)
Telephone No. Business (incl. Area code)
E–mail address
Operation Identifier (if previously assigned by Ministry)

2. Applicant Declaration

As the farm unit operator, I hereby certify that

a. to the best of my knowledge, excluding unforeseen or uncontrollable circumstances, the information contained in this application provides an accurate description of the existing and proposed operation over the time period covered by this plan or strategy,

b. I understand that in the course of the administration of the Act, the Ministry may provide the information contained in this application to external agents or the Ministry of the Environment for review and analysis, and authorize the Ministry to provide this information to its external agents, and authorize its external agents or the Ministry of the Environment to collect this information from the Ministry, and

c. I, the applicant, authorize OR do not authorize
the Certified Nutrient Management Planner who prepared this strategy and/or plan to act as my agent for the purposes of obtaining approval for this application, and to provide the Ministry, or its agents, any information required in the review of this application.

Name of Applicant (please print)

Signature Date (yyyy/mm/dd)

3. Declaration of Individual who Prepared this Strategy and/or Plan

I, the individual who prepared this strategy and/or plan, hereby certify that based on relevant information provided in good faith and excluding unforeseen or uncontrollable circumstances, the recommendations contained in this application will, if implemented, result in acceptable management practices in accordance to the regulation and protocols under the Nutrient Management Act, 2002.

Name of Individual who Prepared this Strategy and/or Plan (please print)

Certification No.(if applicable)

Signature Date (yyyy/mm/dd)

4. Provision of False Information in this Application

Any false or misleading information submitted by the applicant in this document may result in the invalidation of any approvals or permits granted, and prosecution in accordance to the provisions of the Nutrient Management Act, 2002.

**This application may consist of all or some of the following:**
Overview of Operation Farm Unit Declaration Farm Unit Sketch Description of Storage Facilities Description of Generating Facilities Location and Identification of Incoming Prescribed Material Transfers	Nutrient Content of Prescribed Material Destination of Prescribed Material Transfer of Prescribed Material Volume of Prescribed Material Produced Annually Contingency Plan Field Properties Field Sketches	Soil Samples and Analysis Crop Rotation and Yields Tillage Practices Commercial Fertilizer Application Application of Prescribed Materials Agronomic and Crop Removal Balance for Nitrogen and Phosphorus

Notice of Collection

Personal information provided in this application is collected under the authority of the Nutrient Management Act, 2002 and Ontario Regulation 267/03, s. 28(1), s. 29(1) and (1.1), or s. 30(1) and (1.1). It will be used for the review, approval, enforcement and audit of the strategy or plan and research. The information may be made available to external experts contracted by OMAFRA for advice during review and approval, and to the Ministry of the Environment for advice during review and approval or for enforcement purposes. The following information from approved strategies or plans will be used to create a public record:

name of farm operation;
owner of the farm unit and developer of each strategy or plan;
properties covered by the declared farm unit of each strategy or plan;
days storage in each strategy; and
the proportion of the nutrient applied to the declared farm unit of each strategy or plan, and the proportion moved to other properties.

Questions about this collection should be directed to the Manager, Approvals, Nutrient Management Branch, Ministry of Agriculture, Food and Rural Affairs, 1 Stone Road West, Guelph ON N1G 4Y2, Telephone: (519)826–6368.