Confined Animal Feeding Operation Request For Approval Voidance {49827}

INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT Confined Feeding Section Office of Land Quality State Form 49827(R4 / 3-16) 100 North Senate Avenue MC 65-45, IGCN 1101 Indianapolis, Indiana 46204 (800) 451-6027 extension 2-4473 INSTRUCTIONS: Complete all required sections, sign, date, and return this form to the address above. The Request For Exiting The Program Document CONFINED FEEDING OPERATION REQUEST FOR EXITING THE PROGRAM needs to be submitted by the Owner/Operator. I. GENERAL INFORMATION Farm ID Number (Log Number): Date of Last Approval: (month, day, year) (or) Approval Number: County of Operation: AW- Owner/Operator Name (Name to which the Approval was issued): Name of Operation (if applicable): Mailing Address of Owner/Operator: Telephone Number (with area code): ( ) Email Address: Location of Operation (nearest crossroads or mailing address): If any of the above information is unknown, contact IDEM at 317/232-4473. II. EXITING THE PROGRAM I am requesting to exit the Confined Feeding Operations (CFO) program because (check all that apply): My operation currently meets the requirement as defined in 327 IAC 19-16-1(a)(1) and does not meet the definition of a confined feeding operation under the statute IC 13-11-2-40(1) and (3) which states: "Confined feeding operation", for purposes of IC 13-18-10, means: (1) any confined feeding of: (A) at least three hundred (300) cattle; (B) at least six hundred (600) swine or sheep; (C) at least thirty thousand (30,000) fowl; and (D) at least five hundred (500) horses; or (2) AFO electing to be subject to IC 13-18-10; or (3) any animal feeding operation that is causing a violation of: (A) water pollution control laws; (B) any rules of the water pollution control board; or (C) IC 13-18-10. I no longer confine livestock at the above referenced facility. (327 IAC 19-16-3(a)(1)) I have removed all manure stored in pits and/or lagoons at the above referenced facility. (327 IAC 19-16-3(a)(2)) By submitting this request for exiting the CFO program, I understand my request will be reviewed by IDEM staff and a Confined Feeding Compliance Inspector will visit my operation to confirm the declared status. If the farm no longer has animals, the manure must be properly removed from any lagoons, pits, or tanks prior to a compliance inspector visiting the operation. If I am approved to exit the program, I understand I will be removed from the list of approved operations and will not have to meet the requirements of my approval or submit a manure management plan to IDEM once every five (5) years. If I intend at some point in the future to increase the size of my operation above the animal numbers required in IC 13-18-10, I must seek a new approval prior to increasing the size of the operation. III. SIGNATURE I affirm that the information on this form is, to the best of my knowledge and belief, true, complete and accurate. I am aware of the penalties for knowingly submitting false information under IC 13-30-10-1.5. Signature of Owner/Operator Date (month, day, year) American LegalNet, Inc. www.FormsWorkFlow.com