----------------- ------- ------- ------- ------- ------- ------- ------- ------- ----------------- -------------- ---------
  **Animal Feeding                                                                                                   
  Operation Name**                                                                                                   

  **Address**                                                                                                        

  **City, State,                                                                                                     
  Zip Code**                                                                                                         

  **Legal                                                                                                            
  description**                                                                                                      

  **Name and                                                                                                         
  Phone(s) of                                                                                                        
  Owner:**                                                                                                           

  **Name and                                                                                                         
  Phone(s) of                                                                                                        
  Operator:**                                                                                                        

  **Environmental                                                                                                    
  Consultant (if                                                                                                     
  any):**                                                                                                            

  **Crop Consultant                                                                                                  
  (if any):**                                                                                                        

  **Discharge                                                                       **gallons/day**   **Expiration        
  Permit from NM                                                                                      Date:**        
  GWQB:**                                                                                                            

  **EPA CAFO NPDES                                                                                                   
  Permit (if                                                                                                         
  applicable):**                                                                                                     
  ----------------- ------- ------- ------- ------- ------- ------- ------- ------- ----------------- -------------- ---------

+-----------------------------------------------------------------------+
| **Emergency equipment includes:** **(e.g. front end loader, tractors  |
| w/PTO, portable pumps)**                                              |
|                                                                       |
|                                                                       |
+-----------------------------------------------------------------------+

  ----------------------------------- -----------------------------------
  **Distance of Facility to Surface        
  Water or any Well**                 

                                      **(surface water may include a
                                      perennial or intermittent stream,
                                      river, lake, pond, irrigation
                                      canal, or wetland)**
  ----------------------------------- -----------------------------------

  ----------- ----------- ---------- ----------- ----------- ------- --------------- ------- ----------- ----------- ---------------------
  **Depth to                                     **     **                                   **ft                    
  Ground                                                                                     Source:**               
  Water                                                                                                              
  Table:**                                                                                                           

  **Min.                             **     **                                               **ft                    
  Depth to                                                                                   Source:**               
  Ground                                                                                                             
  Water:**                                                                                                           

  **Flow                                                                                                                  
  Direction                                                                                                          
  of Ground                                                                                                          
  Water:**                                                                                                           

                                                                                                                     

              **ID                                                   **Location:**                       **High      
              Number:**                                                                                  nitrates?   
                                                                                                         Yes**       
                                                                                                         **No**      

              **ID                                                   **Location:**                       **High      
              Number:**                                                                                  nitrates?   
                                                                                                         Yes**       
                                                                                                         **No**      

              **ID                                                   **Location:**                       **High      
              Number:**                                                                                  nitrates?   
                                                                                                         Yes**       
                                                                                                         **No**      

              **ID                                                   **Location:**                       **High      
              Number:**                                                                                  nitrates?   
                                                                                                         Yes**       
                                                                                                         **No**      

              **ID                                                   **Location:**                       **High      
              Number:**                                                                                  nitrates?   
                                                                                                         Yes**       
                                                                                                         **No**      

              **ID                                                   **Location:**                       **High      
              Number:**                                                                                  nitrates?   
                                                                                                         Yes**       
                                                                                                         **No**      
  ----------- ----------- ---------- ----------- ----------- ------- --------------- ------- ----------- ----------- ---------------------

+------------------+---------+---------+---------+------------------+
| **Type of        | *       | **      | **Avg.  | **Number of Days |
| Animal(s)**      | *Actual | Planned | Weight  | in System        |
|                  | Animal  | Animal  | (lbs)** | Confined**       |
|                  | #'s**   | #'s**   |         |                  |
+------------------+---------+---------+---------+------------------+
| Milk Cows        |         |         |         | ###              |
+------------------+---------+---------+---------+------------------+
| Heifers          |         |         |         |                  |
+------------------+---------+---------+---------+------------------+
| Calves           |         |         |         |                  |
+------------------+---------+---------+---------+------------------+
|                  |         |         |         |                  |
+------------------+---------+---------+---------+------------------+
|                  |         |         |         |                  |
+------------------+---------+---------+---------+------------------+
|                  |         |         |         |                  |
+------------------+---------+---------+---------+------------------+
|                  |         |         |         |                  |
+------------------+---------+---------+---------+------------------+
|                  |         |         |         |                  |
+------------------+---------+---------+---------+------------------+

  ------------------ ---------- ----------------------------- -------- ----------
  **Total Animal                **Number of times Cows are             **/day**
  Units:**                      Milked:**                              

  ------------------ ---------- ----------------------------- -------- ----------

  ----------- ---------- ---------- --------- --------------- ---------- ----------
  **Bedding                                   **Barn                     
  \*(Loads,                                   Wash/Flush                 
  Tons, or                                    Water                      
  Bales)**                                    (Gallons)**                

  Type of     \*Amount   How Often  Total     Amount of Water How Often  Total Used
  Bedding     Used       (D/W/or M) Tons Used                 (D/M/or    
                                    (Yr)                      Yr)        

                                                                              

                                                                              

                                                                              
  ----------- ---------- ---------- --------- --------------- ---------- ----------

D=daily, W=weekly, M=monthly, Yr=yearly

  --------- ------------------- --------------------------- -------------
  **Teat                        **Hoof Dip:**                    
  Dip:**                                                    

  --------- ------------------- --------------------------- -------------

**Is Alley Flush System in use: Yes** **No**

  -------------------- ----------- ----------- ----------- ----------- -----------------------------------------------
  **What type of water                                                 **     **
  is used:**                                                           

  **Gallons/Flush:**   **     **                                       

  **How Many                                               **     **   
  Times/Day:**                                                         

  **Where is it                                **     **               
  Collected:**                                                         

  **Where is it                    **     **                           
  Stored:**                                                            
  -------------------- ----------- ----------- ----------- ----------- -----------------------------------------------

Housing (Describe the type of housing such as open lot, free stall,
stanchion; and number and type of animals housed):

  -----------------------------------------------------------------------
       

  -----------------------------------------------------------------------

Roof and/or Runoff (Describe how runoff is collected and/or diverted and
if so how):

  -----------------------------------------------------------------------
       

  -----------------------------------------------------------------------

  ------------------ ------------ ---------------------------------------
  **Barn Lot                      **     **
  (loafing area)                  
  Surface Type:**                 

  **Barn Lot Size    **     **    
  (sq ft):**                      
  ------------------ ------------ ---------------------------------------

**What is the size and type of cover of the runoff area:**

  ------------ --------------------- ------ --------------- ---------------
  **Type of    **     **                    **     **       **acres**
  cover**                                                   

  **Type of    **     **                    **     **       **acres**
  cover**                                                   

  **Type of    **     **                    **     **       **acres**
  cover**                                                   

  **Type of    **     **                    **     **       **acres**
  cover**                                                   
  ------------ --------------------- ------ --------------- ---------------

  ----------------------- -------------- ----------- -----------------------
  **What is the storage                  **     **   **ac. ft.**
  capacity of the runoff                             
  pond:**                                            

  **Type of holding pond  **     **                  **(clay, synthetic,
  liner:**                                           none...)**
  ----------------------- -------------- ----------- -----------------------

Dead Animal and Veterinary Waste Management (Describe how dead animals
and veterinary waste are disposed of and by whom):

  -----------------------------------------------------------------------
       

  -----------------------------------------------------------------------

**Describe how solid and liquid manure is collected, transferred,
treated, and stored (Include how often, method used, storage sizes,
equipment used, manure test values, etc. How often is manure
scraped/cleaned? Where is manure stored? Attach manure test
information)**

Solid:

  -----------------------------------------------------------------------
       

  -----------------------------------------------------------------------

Liquid: (how is wash water collected at the barn; how is wash water
transferred to holding ponds -- pipeline size, pump, gravity...; how are
the solids in wash water separated -- screen separator, passive tank,
...)

  -----------------------------------------------------------------------
       

  -----------------------------------------------------------------------

  ---------------------------------------- ----------- --------------------
  **What is the storage capacity of the    **     **   **ac. ft.**
  holding ponds:**                                     

  ---------------------------------------- ----------- --------------------

  ----------------------- --------------------------- --------------------
  **Type of holding pond  **     **                   **(clay, synthetic,
  liner:**                                            none)**

  ----------------------- --------------------------- --------------------

  -------------- ---------------- ------ -------- ----------- ------------ -------
  **Crop                                 **Farm               **Tract:**   
  Rotation:**                            \# :**                            

  **Acres                                                     **acres**    
  Farmland Owned                                                           
  by Facility:**                                                           
  -------------- ---------------- ------ -------- ----------- ------------ -------

Field Information:

+-------+-----+-------+------+----+-----+------+--------+---------+
| #     | **D | #     | *    | *  | **  | **   | **\*Re | ##### S |
| **Fie | ate | ##### | *Acr | *Y | Gra | \*NM | source | ensitiv |
| ld \# | (y  |  Crop | es** | ie | zed | PI** | Conc   | e Areas |
|  or N | ear |       |      | ld | (   |      | erns** | /Site P |
| ame** | )** |       |      | ** | Y/N |      |        | roblems |
|       |     |       |      |    | )** |      |        |         |
+-------+-----+-------+------+----+-----+------+--------+---------+
|       |     |       |      |    | ### |      |        |         |
|       |     |       |      |    |     |      |        |         |
|       |     |       |      |    |     |      |        |         |
+-------+-----+-------+------+----+-----+------+--------+---------+
|       |     |       |      |    | ### |      |        |         |
|       |     |       |      |    |     |      |        |         |
|       |     |       |      |    |     |      |        |         |
+-------+-----+-------+------+----+-----+------+--------+---------+
|       |     |       |      |    | ### |      |        |         |
|       |     |       |      |    |     |      |        |         |
|       |     |       |      |    |     |      |        |         |
+-------+-----+-------+------+----+-----+------+--------+---------+
|       |     |       |      |    | ### |      |        |         |
|       |     |       |      |    |     |      |        |         |
|       |     |       |      |    |     |      |        |         |
+-------+-----+-------+------+----+-----+------+--------+---------+
|       |     |       |      |    | ### |      |        |         |
|       |     |       |      |    |     |      |        |         |
|       |     |       |      |    |     |      |        |         |
+-------+-----+-------+------+----+-----+------+--------+---------+
|       |     |       |      |    | ### |      |        |         |
|       |     |       |      |    |     |      |        |         |
|       |     |       |      |    |     |      |        |         |
+-------+-----+-------+------+----+-----+------+--------+---------+
|       |     |       |      |    | ### |      |        |         |
|       |     |       |      |    |     |      |        |         |
|       |     |       |      |    |     |      |        |         |
+-------+-----+-------+------+----+-----+------+--------+---------+
|       |     |       |      |    | ### |      |        |         |
|       |     |       |      |    |     |      |        |         |
|       |     |       |      |    |     |      |        |         |
+-------+-----+-------+------+----+-----+------+--------+---------+

\***NMPI**=New Mexico Phosphorus Index; **Resource Concerns**=Soil,
Water, Air, Plant, or Animal**; Sensitive Areas**=areas next to water,
wetlands, etc.; **Site Problems** = Problems such as rocky or sandy
soils, watertables, shallow soil depths, steep slopes, etc.

Farmland that allows waste utilization by dairy:

  -------------- ------------------------------- -------------- --------------
  **Location**   **     **                       **Acres**      **     **

  **Location**   **     **                       **Acres**      **     **

  **Location**   **     **                       **Acres**      **     **

  **Location**   **     **                       **Acres**      **     **
  -------------- ------------------------------- -------------- --------------

**Irrigation Wells (locate on map):**

  -------------- ------------------------------- -------------- --------------
  **Location**   **     **                       **gpm**        **     **

  **Location**   **     **                       **gpm**        **     **

  **Location**   **     **                       **gpm**        **     **

  **Location**   **     **                       **gpm**        **     **
  -------------- ------------------------------- -------------- --------------

Describe how solid and liquid manure is utilized (Include time manure is
applied, amount applied, crop(s) and acres applied to, how and when
incorporated, equipment used, etc., or other ways manure is utilized
such as for composting, bedding, or feed, how many tons of manure hauled
offsite annually):

Solid:

  -----------------------------------------------------------------------
       

  -----------------------------------------------------------------------

Liquid: (when is wash water applied, what is the mixture ratio of wash
water to irrigation water, how is the wash water applied, type of
irrigation system, ...)

  -----------------------------------------------------------------------
       

  -----------------------------------------------------------------------

  ------------- ---------------- ------------ ---------------- ---------- -------------
  **Manure                                                                
  Application                                                             
  Equipment**                                                             

  **Type of     **Dimensions     **Capacity   **Number and     **Spread   **Spread
  Spreader**    (l-w-h)(dia)**   (ft^3^, bu,  Kind of Spreader Width      Distance
                                 gal)**       Setting(s)**     (ft)**     (ft)**

                                                                               

                                                                               
  ------------- ---------------- ------------ ---------------- ---------- -------------

Length, w=width, h=average height when full of manure, ft^3^=cubic feet,
bu=bushels, gal=gallons, type of spreader=box, slurry, tank, etc., kind
of spreader settings=PTO, apron, etc.

+------+--------+---------+------+------+-----+--------+------------+
| ##   |        |         |      |      |     |        |            |
|  Irr |        |         |      |      |     |        |            |
| igat |        |         |      |      |     |        |            |
| ion  |        |         |      |      |     |        |            |
| Wate |        |         |      |      |     |        |            |
| r Ma |        |         |      |      |     |        |            |
| nage |        |         |      |      |     |        |            |
| ment |        |         |      |      |     |        |            |
+------+--------+---------+------+------+-----+--------+------------+
| **F  | **     | *       | **F  | **W  | *   | **\#   | **Volume   |
| ield | Method | *Stream | ield | idth | *Ho | of     | of         |
| \#   | of     | Size    | Le   | of   | urs | Irriga | Effluent   |
| or   | Irriga | (cfs or | ngth | Sets | /Se | -tions | Applied**  |
| Na   | tion** | gpm)**  | (f   | (f   | t** | /Yr.** |            |
| me** |        |         | t)** | t)** |     |        | **Ac.ft.** |
+------+--------+---------+------+------+-----+--------+------------+
|      |        |         |      |      |     |        |            |
|      |        |         |      |      |     |        |            |
+------+--------+---------+------+------+-----+--------+------------+
|      |        |         |      |      |     |        |            |
|      |        |         |      |      |     |        |            |
+------+--------+---------+------+------+-----+--------+------------+
|      |        |         |      |      |     |        |            |
|      |        |         |      |      |     |        |            |
+------+--------+---------+------+------+-----+--------+------------+
|      |        |         |      |      |     |        |            |
|      |        |         |      |      |     |        |            |
+------+--------+---------+------+------+-----+--------+------------+

Method of Irrigation=wheeline, border, furrow, etc., cfs=cubic feet per
second, gpm=gallons per minute

  --------------------- ------------------------- -----------------------
  **Irrigation Water    **     **                 **ac./ft./yr.**
  Rights:**                                       

  --------------------- ------------------------- -----------------------

**Irrigation Water Delivery (Include if source is from a stream or well,
if it is delivered on demand or on turns or some other way, variability
of stream size, No~3~** --N PPM in Water etc.):

  -----------------------------------------------------------------------
       

  -----------------------------------------------------------------------

  -------------- ----------- ----------- -------------- ---------- ----------- ----------- --------- ------------
  **Grazing                                                                                          
  Management**                                                                                       

  **\*Field \#   **Acres**   **Yield**   **Grass/Crop   **Animal   **\# of     **Average   **Days on **Month(s)
  or Name**                              Grown**        Type**     Animals**   Weight**    Field**   on Field**

                                                                                                          

                                                                                                          

                                                                                                          

                                                                                                          

                                                                                                          

                                                                                                          

                                                                                                          
  -------------- ----------- ----------- -------------- ---------- ----------- ----------- --------- ------------

\*Include only those fields where manure is or will be applied in
addition to grazing

Feed management (Describe any measures that are or will be used to alter
manure nutrient content through feed management such as phytase feeding,
milk urea nitrogen testing, etc.):

  -----------------------------------------------------------------------
       

  -----------------------------------------------------------------------

Conservation Practices You Believe Are Needed (List and describe the
practices such as changes needed in collection, storage, treatment,
transfer, or utilization, changes in land management practices, animal
numbers or type, feed management, etc.):

  -----------------------------------------------------------------------
       

  -----------------------------------------------------------------------

**Tillage Type and Timing:**

  --------------------- -------------------------------------------------
  **Crop Rotation       **     **
  Sequence**:           

  --------------------- -------------------------------------------------

  ---------------------------------------------------- ------------------
  **Tillage Name**                                     **Date**

                                                            

                                                            

                                                            

                                                            

                                                            

                                                            

                                                            

                                                            

                                                            

                                                            

                                                            

                                                            

                                                            
  ---------------------------------------------------- ------------------

  --------------------- -------------------------------------------------
  **Crop Rotation       **     **
  Sequence**:           

  --------------------- -------------------------------------------------

  ---------------------------------------------------- ------------------
  **Tillage Name**                                     **Date**

                                                            

                                                            

                                                            

                                                            

                                                            

                                                            

                                                            

                                                            

                                                            

                                                            

                                                            

                                                            
  ---------------------------------------------------- ------------------

#### Pesticide Application

+------------+--------------------+----------------+------------------+
| ####       |                    |                |                  |
| Herbicides |                    |                |                  |
+------------+--------------------+----------------+------------------+
| **Crop**   | **Weeds (Pests)**  | **Chemical     | **Application    |
|            |                    | used**         | Rate**           |
+------------+--------------------+----------------+------------------+
|            |                    |                |                  |
+------------+--------------------+----------------+------------------+
|            |                    |                |                  |
+------------+--------------------+----------------+------------------+
|            |                    |                |                  |
+------------+--------------------+----------------+------------------+
| #### In    |                    |                |                  |
| secticides |                    |                |                  |
+------------+--------------------+----------------+------------------+
| **Crop**   | **Insect (Pests)** | **Chemical     | **Application    |
|            |                    | used**         | Rate**           |
+------------+--------------------+----------------+------------------+
|            |                    |                |                  |
+------------+--------------------+----------------+------------------+
|            |                    |                |                  |
+------------+--------------------+----------------+------------------+

+------------+--------------------+----------------+------------------+
| #### Disea |                    |                |                  |
| se Control |                    |                |                  |
+------------+--------------------+----------------+------------------+
| **Crop**   | **Cause            | **Chemical     | **Application    |
|            | (Disease)**        | used**         | Rate**           |
+------------+--------------------+----------------+------------------+
|            |                    |                |                  |
+------------+--------------------+----------------+------------------+
|            |                    |                |                  |
+------------+--------------------+----------------+------------------+