Agricultural Waste Destruction Certification Form
Please complete all required fields to certify the destruction of agricultural waste. All references use the exact form title.
Farm or Business Name
*
Contact Person Full Name
*
First Name
Last Name
Contact Email Address
*
example@example.com
Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Type of Agricultural Waste
*
Please Select
Crop Residue
Animal Waste
Pesticide Containers
Plastic Mulch/Film
Other
Description of Waste (Details, if Other)
*
Quantity or Volume Destroyed (specify units)
*
Date of Destruction
*
-
Month
-
Day
Year
Date
Method of Destruction
*
Please Select
Composting
Incineration
Burial
Land Application
Other
Location of Destruction (Field/Facility Address or Coordinates)
*
Upload Supporting Evidence (e.g., photos, documents)
Upload a File
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of
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