Reporting Period: September 1, , through August 31,
This form must be completed and submitted annually by January 31st for the previous cropping year. Attach to this form a copy of all laboratory analysis results. In addition, be sure to send any requested information to City, Township, and County officials.
I certify that I am familiar with the information contained in this report and that to the best of my knowledge and belief the information is true, accurate and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment.
Principal executive officer/authorized agent: Type IV certified operator:
www.pca.state.mn.us • 651-296-6300 • 800-657-3864 • TTY 651-282-5332 or 800-657-3864 • Available in alternative formats