Date:      Today is

Farm Name:

Owner/Operator:

Manager:

Mailing Address:

Telephone:

Your Email Address:

Other Email Addresses:

Avg. Milk Production?   lbs/cow/year
                                          OR
                                     lbs/cow/day

Type of cow housing (freestalls, pack barns, etc)?

Type and size of milking parlor?

Major sources of forage?

(Please select Yes or No for the following.)

DHI Affiliate?   Yes    No

If no, name of other dairy record programs used:

Any plans for expansion?   Yes    No

Do you plan to exit the dairy business soon?   Yes    No

If economically justified, would you contract raise your heifers?   Yes    No

(Please check all that apply for the following.)

Waste Management:

	Daily scrape and haul (ex. Manure spreader; applied semi-daily; no extended storage)
	Dry stack (ex. Stored in covered facility; handled as a solid)
	Slurry pit (ex. Deep pit storage; covered concrete or metal tanks; handled as a liquid)
	Holding pond (ex. Manure & dilution water stored in a pond; mixed & emptied annually)
	Anaerobic lagoon (ex. Very dilute; liquid removed semi-annually; solids removed every 2-25 yrs)

Land Application Methods:

	Broadcast-no incorporation (ex. Manure spreader; slurry tank application)
	Broadcast-incorporate w/in 12hrs (ex. Incorporation w/chisel-plow, disking, etc.)
	Knife or sweep injected (ex. Liquid manure applied below soil surface)
	Irrigated-no incorporation (ex. Liquid manure applied using irrigation equipment)

Comments: