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Agricultural Inputs Instructions: Includes all applications from pre-planting through to, and including, harvest. One Form must be completed for EACH PRODUCTION SITE. Producer Name: Previous Year Crop(s): Production Site Information (e.g., Field # or Name/ID): Production Site Area Current Crop: Date Planted: Variety: (e.g., # of acres/hectares): COMMERCIAL FERTILIZER APPLICATION Date Blend Rate Fertilizer Lot # (if applicable) Applicator’s Name Canadian Horticultural Council, Combined Vegetable Producer, Storage Intermediary and Packer On-Farm Food Safety Manual, Version 4.0, 2010, Canadian Horticultural Council. Agricultural Inputs MANURE*/COMPOST/COMPOST TEA/OTHER BY-PRODUCTS/PULP SLUDGE#/SOIL AMENDMENT/MULCH APPLICATIONS Date What is Applied Type* Supplier’s Name Rate Earliest Allowable Harvest Date* (according to appropriate time delay) Applicator’s Name * Manure (cattle, hog, poultry, horse, etc.) # Pulp sludge is the solid residue that remains after wastewater is treated at pulp and paper mills. It mainly consists of wood fibre, lime, and clays, as well as excess organisms produced as part of the wastewater treatment process. Other by-product (seafood waste, vegetable culls, etc.) Canadian Horticultural Council, Combined Vegetable Producer, Storage Intermediary and Packer On-Farm Food Safety Manual, Version 4.0, 2010, Canadian Horticultural Council.