SF 49827 (7-00) Confined Animal Feeding Operation Request for Approval Voidance (Required Form) To submit a request to have your approval voided and removed from the Confined Feeding Approval system, this form must be completed, signed, dated, and returned to: Jerome Rud, Chief Solid Waste Permits Section Office of Land Quality Indiana Department of Environmental Management 100 North Senate Avenue P.O. Box 6015 Indianapolis, Indiana 46206-6015 Approval Number, AW- ______________________ (or) Log Number,__________________________ Date of application approval (or most recent approval update):_________________________________ Owner Name (Name to which most recent approval was issued):_______________________________ Mailing address of owner:______________________________________________________________ Telephone Number (with area code):______________________________________________________ Name of Operation (if applicable):________________________________________________________ Location of Operation (nearest crossroads or mailing address):_________________________________ County of Operation:__________________________________________________________________ If any of the above information is unknown, contact your Local County Extension Agent or IDEM at 317/232-4473. I am requesting my approval be voided because (check all that apply): “ My operation currently does not meet the definition of a confined feeding operation under the statute IC 13-11-2-40(1) and (3) which states: "Confined feeding operation", for purposes of IC 13-18-10, means: (1) any confined feeding of: (A) at least three hundred (300) cattle; (B) at least six hundred (600) swine or sheep; and (C) at least thirty thousand (30,000) fowl; or (3) any animal feeding operation that is causing a violation of: (A) water pollution control laws; (B) any rules of the water pollution control board; or (C) IC 13-18-10. “ I no longer confine livestock at the above referenced facility. “ I have removed all manure stored in pits and/or lagoons at the above referenced facility. By submitting this request for voidance I understand that my request will be reviewed by IDEM staff and an Agricultural Waste Inspector will visit my farm to confirm that manure has been properly removed from any lagoons, pits, or tanks. If a voidance is granted, I understand that I will be removed from the list of approved operations and will not have to meet the requirements of my approval or submit a manure management plan to IDEM once every five (5) years. If I intend at some point in the future to increase the size of my operation above the animal numbers required in IC 13-18-10 I must seek a new approval prior to increasing the size of the operation. By signing this form I attest that the information provided above is true and accurate. _____________________________________ Signature _____________ Date American LegalNet, Inc. www.FormsWorkflow.com Filename: Approval Voidance-SF49827.doc Directory: A: Template: C:\Program Files\Microsoft Office\Templates\Normal.dot Title: Subject: Author: John Hale Keywords: Comments: Creation Date: 10/17/02 9:30 AM Change Number: 2 Last Saved On: 10/17/02 9:30 AM Last Saved By: idem Total Editing Time: 0 Minutes Last Printed On: 01/30/03 1:49 PM As of Last Complete Printing Number of Pages: 1 Number of Words: 454 (approx.) Number of Characters: 2,588 (approx.) American LegalNet, Inc. www.FormsWorkflow.com