ODAFF AEMS Daily Emergency Land Application Report Form

Transcription

ODAFF AEMS Daily Emergency Land Application Report Form
AEMS127
4/2015 Rev
ODAFF AEMS Daily Emergency Land Application Report Form
Name of Facility
Facility Contact
Phone
Oklahoma CAFO License Number
Today’s Date
Jeremy Seiger, Director, 405-522-4659
[email protected]
Sally Abbott, Adm. Pgm. Officer, 405-522-5892
[email protected]
AEMS Fax No. 405-522-6357
Signature
Weather Conditions During Application and any Measurable Rainfall for the Day:
Date of
Application
Application
Start Time
Application
End Time
Beginning
Pole Depth
(Freeboard)
Ending Pole
Depth
(Freeboard)
Total Gallons
Pumped
# of Acres
Land Applied
To
Field ID
Legal Description
Crop/Forage
Cover
Notes:
This form must be faxed or e-mailed, to both addresses shown above, to the ODAFF, AEMS Division, by 10:30 a.m. the next day whether or not application took
place, including weekends and holidays.

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