**Concentrated Animal Feeding Operation (CAFO) Annual Report**  **EPA Regulations –**  **122.42(e) Example Data Entry Form**  [ **Note:** Users will also be able to batch this data into this form via a spreadsheet or CSV file. ] NPDES Number <system generated> Start Date of Reporting Period (YYYY

- MM
- DD) End Date of Reporting Period (YYYY

- MM
- DD) NPDES Data Group Number 5 <system generated> **I. TYPE AND NUMBER OF ANIMALS**  Please report the maximum number of each type of animal held at your facility during the reporting period . Please only count animals held at your facility for 45 days or more
. **CAFO Animal**  **Type Maximum Number**  **of Animals Maximum Number**  **of Animals in Open Confinement**  Mature Dairy Cows Dairy Heifers Veal Calves Other Cattle Swine (55 lbs or more) Swine (55 lbs or less) Horses Sheep or Lambs Turkeys Chicken (broilers) Chicken (layers) Ducks Other, please specify: ________________**II. MANURE, LITTER, AND PROCESS WASTEWATER PRODUCTION**  **(MLPW)**

Please report the total amount of manure, litter, and process wastewater generated or generated and transferred by your facility during the reporting period
. **MLPW Type MLPW**  **Generated Amounts**  **( during reporting**  **period) MLPW Transferred Amounts**  **( during reporting period**  **) MLPW**  **Units (e.g. tons, gallons, etc)**  **Manure Litter**  **Process Wastewater III.**  **Land Application -**  **Acres Covered by Plan** Total number of acres for land application covered by the current nutrient management plan The total number of acres under control of the CAFO and used for land application in the reporting period. **IV. Summary of**  **Production Area Discharges**  Please use this table to provide information discharges from your production area. **Discharge Type** ***** **Disco very Dates of Discharges**  **from Production Area Duration of Discharges from**  **Production Area Volume of Discharge from**  **Production Area (gallons)**

* **Note:** This is a unique code/description that identifies for each discharge from the permittee’s production area in the reporting period whether a 25
-year, 24
- hour rainfall event was the cause for the discharge.**V. Nutrient Management Plan** 

Was the current version of this facility’s NMP prepared or approved by a certified nutrient manage ment planner? Yes No **IV. Land Application Summary** Please use the following table to report the nitrogen (N) and phosphorous (P) content of manure, litter, and process wastewater using the results of the most recent representative manure, litter, and process wastewater tests for N and P . Report the form of N an d P (e.g., total nitrogen, ammonium nitrogen, total phosphorous) used fo r nutrient management planning purposes in the **Nutrient Form** column. **MLPW Type Nitrogen Content**  **Phosphorus Content Units**  **Nutrient Form Manure**  **Litter Process Wastewater**  For each field to which CAFO MLPW was applied in the reporting period, please report the actual crop(s) planted, the a ctual crop yield(s) and units along with method for calculating maximum amounts of MLPW (i.e., Linear or Narrative Rate Approach ). **Unique Field ID**  **Actual Crop(s) Planted Actual Crop Yield(s)**  **Actual Crop Yield Units**  **Linear or Narrative Rate Approach**

Please indicate the amount of MLPW and supplemental fertilizer applied to each field.
**Unique Field ID**  **CAFO MLPW Land Application Maximum Amount CAFO MLPW Land Application**  **Actual Amount**  **Manure Units: ________**  **Litter Units: ________**  **Process**

**Wastewater Units: ________**  **Manure**

**Units: ________ Litter** 

**Units: ________ Process** 

**Wastewater Units: ________**  * * * * This column will be prepopulated based on the preceding table
.

### Standard Signature Block and Certification Statement for CWA Reporting (in compliance with CFR Parts 3, 122.22, and 127). **INSTRUCTIONS:** Please complete the following table if you are using the narrative rule approach as described under 40 CFR 122.42(e)(5)(ii). Otherwise, please sign and submit this form. For each field used for land application, report the results of the most recent soil nutrient analyses for any soil test taken in the reporting period
. Report the form of N and P (e.g., total nitrogen, ammonium nitrogen, total phosphorous) used for nutrient management planning purposes in the **Nu trient Form**  column. **Unique Field ID**  **Most Recent Soil Test Results Amount of Any Supplemental Fertilizer Applied** 

**Nitrogen Content**  **Phosphorus**

**Content Nutrient** 

**Form Unit**  **Nitrogen Content**  **Phosphorus**

**Content Unit** 
* * * * * * * This column will be prepopulated based on the preceding table.

SUBMIT REPORT