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*For Your Farm*

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  **NAME:**        

  **FARM:**        
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Table of Contents

Land Operator Information [3]{.underline}

Property Location [4]{.underline}

Recordkeeping [5]{.underline}

Sediment Management [7]{.underline}

**Certification Statement [8]{.underline}**

**Notes [9]{.underline}**

# 

# Land Operator Information

The following information is needed by your conservation planner to
develop a quality conservation plan.

  ---------------- -------------- ------- ------- ------- ------- ------- ------- ------- ------- -------------------- ----------- ------- ----------------------
  **Name of                                                                                                                                
  Landowner(s)**                                                                                                                           

  **Name of Land                                                                                                                           
  Manager(s)**                                                                                                                             

  **Business or                                                                                                                            
  Farm Name**                                                                                                                              

  **Address**                                                                                                                              

  **City**                                                                                                             **State**           

  **Parish**                                                                                                           **Zip                    
                                                                                                                       Code**              

  **Phone                                                                                                                                  
  Numbers**                                                                                                                                

                   **Home**                                                                                                                

                   **Business**                                                                                                            

                   **Cell**                                                                                                                

  **E-mail                                                                                                                                 
  Address**                                                                                                                                
  ---------------- -------------- ------- ------- ------- ------- ------- ------- ------- ------- -------------------- ----------- ------- ----------------------

Notes

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#  Property Location

In order to identify the property location, please fill out the table
below. Your tract number and total acres can be located on an aerial
map. Aerial map photocopies of your property can be obtained at your
local US Department of Agriculture Service Center.

  -------------------- ---------- -------------------- ----------- --------- -------------
  **Property Name**    **Tract    **Field Number(s)**  **Acres**   **Own**   **Operate**
                       Number**                                              

  Jones Farm           T-1222     1,2,3,5,6,7,8,9,10   150         Yes       

  Jones Farm           T-2345     1,2,3,4,5,6,7,8,9    450                   Yes

  **Property Name**    **Tract    **Field Number(s)**  **Acres**   **Own**   **Operate**
                       Number**                                              

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

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

#  Fertilizer, Pesticides, and Agricultural Waste Recordkeeping

This document provides a uniform method for documenting the application
of nutrient and pest management and waste utilization that will be used
in all NRCS field offices in Louisiana.

  ------------ --------- --------- ----------- ----------------- --------------- -------------------- -------------------- --------------------
  **Property   **Tract   **Field   **Acres**   **Crop/Forage**   **Date of       **Fertilizer /       **Rate Per Acre      **Method of
  Name**       \#**      \#**                                    Application**   Pesticides /         [2]{.underline}/**   Application
                                                                                 Agricultural Waste                        [3]{.underline}/**
                                                                                 [1]{.underline}/**                        

                                                                                                                                

                                                                                                                                

                                                                                                                                

                                                                                                                                

                                                                                                                                

                                                                                                                                

                                                                                                                                

                                                                                                                                

                                                                                                                                

                                                                                                                                

                                                                                                                                

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

1.  Pesticide name, fertilizer type (N, P, K), waste type (lagoon
    solids, dry stack, litter)

2.  Pounds per acre of nitrogen, P2O5, or, K2O, or pounds per acre

3.  Broadcast, band, aerial, incorporate, foliar

  ------------ --------- --------- ----------- ----------------- --------------- -------------------- -------------------- --------------------
  **Property   **Tract   **Field   **Acres**   **Crop/Forage**   **Date of       **Fertilizer /       **Rate Per Acre      **Method of
  Name**       \#**      \#**                                    Application**   Pesticides /         [2]{.underline}/**   Application
                                                                                 Agricultural Waste                        [3]{.underline}/**
                                                                                 [1]{.underline}/**                        

                                                                                                                                

                                                                                                                                

                                                                                                                                

                                                                                                                                

                                                                                                                                

                                                                                                                                

                                                                                                                                

                                                                                                                                

                                                                                                                                

                                                                                                                                

                                                                                                                                

                                                                                                                                

                                                                                                                                

                                                                                                                                

                                                                                                                                

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

1/ Pesticide name, fertilizer type (N, P, K), waste type (lagoon solids,
dry stack, litter)

2/ Pounds per acre of nitrogen, P2O5, or, K2O, or pounds per acre

3/ Broadcast, band, aerial, incorporate, foliar

##  

## Sediment Management

This document gathers information related to conservation practices you
have applied on your farm that reduce or prevent sediment from moving
off your land. List the tract and field number(s) where these practices
have been installed and are being maintained.

<table>
<colgroup>
<col style="width: 12%" />
<col style="width: 9%" />
<col style="width: 11%" />
<col style="width: 9%" />
<col style="width: 9%" />
<col style="width: 9%" />
<col style="width: 9%" />
<col style="width: 9%" />
<col style="width: 9%" />
<col style="width: 9%" />
</colgroup>
<tbody>
<tr class="odd">
<td><strong>Property Name</strong></td>
<td><strong>Tract Number</strong></td>
<td><strong>Field Number(s)</strong></td>
<td><strong>Field Border</strong></td>
<td><strong>Filter Strip</strong></td>
<td><strong>Grassed Waterway</strong></td>
<td><strong>Irrigation Water Mgmt</strong></td>
<td><p><strong>Riparian Forest</strong></p>
<p><strong>Buffer</strong></p></td>
<td><strong>Row Arrangement</strong></td>
<td><strong>Grade Stabilization Structure</strong></td>
</tr>
<tr class="even">
<td>Jones Farm</td>
<td>T-1222</td>
<td>1,2,3,5,6,7,8,9,10</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>Jones Farm</td>
<td>T-2345</td>
<td>1,2,3,4,5,6,7,8,9</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>     </td>
<td>     </td>
<td>     </td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>     </td>
<td>     </td>
<td>     </td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>     </td>
<td>     </td>
<td>     </td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>     </td>
<td>     </td>
<td>     </td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>     </td>
<td>     </td>
<td>     </td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>     </td>
<td>     </td>
<td>     </td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>     </td>
<td>     </td>
<td>     </td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
</tbody>
</table>

### 

### Certification Statement

The information entered in this document is correct to the best of my
knowledge. I understand that if requested, I can provide a minimum of
two years of documentation to support the information provided.

**Name:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Date: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

### Notes 

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