This Survey assesses the risk to surface and ground water associated with the Pesticide Handling and Storage operation on the basis of the answers to the survey questions. Please answer all questions for a fair evaluation.

Mixing and Loading Practices:

1. Where do you get the water that you mix with the pesticide?

Directly from well
Tank separate from well
Corresponding magnitude of risk
 

2. What is the minimum distance between any fertilizer mixing/loading area and your well?

Less than 20 feet
Between 20 and 100 feet
More than 100 feet
Corresponding magnitude of risk
 

3. Are all fertilizer mixing/loading areas downslope from the water well?

Yes
No
Corresponding magnitude of risk
 

4. What precautions do you take to prevent back-siphoning?

Permanent air gap
Water tank separate from well
Anti-backflow devices
None of the above
Corresponding magnitude of risk
 

5. Have you ever dropped a water supply hose below the fluid level in the mixing tank?

Yes
No
Corresponding magnitude of risk
 

6. Is someone present during pesticide mixing/loading operations to watch for spills and other mishaps and to take corrective action?

Present entire time
Present most of the time
Start filling, leave and return after set time
Corresponding magnitude of risk
 

7. Have you ever had a spill that you did not clean up?

Yes
No
Corresponding magnitude of risk
 

8. Are there signs, such as dead vegetation, that indicate chemical movement away from the mixing/loading area?

Permanent dead vegetation
Some patches of dead vegetation
No signs, vegetation healthy
Corresponding magnitude of risk
 

9. What is the condition of the mixing/loading area?

Concrete pad with curbs/no cracks,or sealed cracks
Concrete pad/no curbs, no cracks
No pad, soil or gravel surface
Corresponding magnitude of risk
 

Storage:

10. Are most of your pesticides stored within 20 feet of:

a) water well?

Yes
No
Corresponding magnitude of risk
 

b) surface water?

Yes
No
Corresponding magnitude of risk
 

11. Is your pesticide storage area locked to prevent accidental valve opening or vandalism?

Yes
No
Corresponding magnitude of risk
 

12. What type of floor does your pesticide storage area have?

Concrete floor
Soil or gravel floor
Corresponding magnitude of risk
 

13. Are there inside drains in the pesticide storage area?

No
Yes, drain has sump to holding tank
Yes, drain empties to a field tile
Yes, drain runs to city sewer
Corresponding magnitude of risk
 

14. Do you store any cancelled or banned pesticides?

No
Yes, store in its own secondary containment (can in a can) to catch leak
Yes, not stored in any special manner
Corresponding magnitude of risk
 

15. In case of fire, does your fire department know that the chemical storage area should be left to burn and no water should be added?

Yes
No
Corresponding magnitude of risk
 

Cleanup and Container Disposal:

16. Where do you apply the rinsate from pesticide sprayers?

Field
Farmyard, more than 100 feet from well
Farmyard, less than 100 feet from well
Corresponding magnitude of risk
 

17. Where do you clean pesticide application equipment?

Field
Farmyard, more than 100 feet from well
Farmyard, less than 100 feet from well
Corresponding magnitude of risk
 

18. Where do you dispose of pesticide containers?

Farm dump or burn pile on farm
Recycle or landfill
Corresponding magnitude of risk
 

19. Do you triple rinse plastic pesticide containers prior to disposal?

Sometimes
Always
Corresponding magnitude of risk
 

Other Management:

20. Do you store all pesticides together?  

Yes
No
Corresponding magnitude of risk
 

21. Do you use containers for other purposes?  

Yes
No
Corresponding magnitude of risk
 

22. Is the pesticide storage area clean and neat?  

Yes
No
Corresponding magnitude of risk
 

23. Do you keep a current pesticide inventory onsite?

Yes
No
Corresponding magnitude of risk
 

24. Are containers marked with purchase date?

Yes
No
Corresponding magnitude of risk
 

25. Are materials separated by type (herbicide, insecticide)?

Yes
No
Corresponding magnitude of risk
 

26. Are pesticides stored in the original containers?

Yes
No
Corresponding magnitude of risk
 

27. Are pesticides stored off the floor and low to ground?

Yes
No
Corresponding magnitude of risk
 

28. Are dry formulations stored on pallets?

Yes
No
Corresponding magnitude of risk
 

29. Are storage areas free of spills and leaks?

Yes
No
Corresponding magnitude of risk
 

30. Do you have a shovel and absorbent materials readily available?

Yes
No
Corresponding magnitude of risk
 

31. Are "Keep Out" signs posted?

Yes
No
Corresponding magnitude of risk
 

32. Is the storage area well-lit and ventilated?

Yes
No
Corresponding magnitude of risk
 

33. Is there pesticide safety equipment in the pesticide storage area?  

Yes
No
Corresponding magnitude of risk
 

Net Survey Score:
Magnitude of risk:

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