PCO Forest Grown System Plan - American Ginseng Office Use Only Received: Forest Grown System Plan – American Ginseng SECTION 1: General Information Contact Information: Today’s date: Company Name: First Name: MI: Last Name: Phone: Fax: Address: E-mail: City: State: Zip code: Website: I am a licensed ginseng dealer Indicate state(s) licensed in and corresponding license number(s): Harvest Area Information (if different from above): Same as above N/A Operation Name: Harvest Area Address or GPS Coordinates: City: State: Zip code: Check which type of operation you are requesting verification as: Producer/Harvester (complete all sections except Section 5) Processor/Handler (complete Sections 5 to 7 and 9) If Producer/Harvester, select the type(s) of management system(s) that apply to your operation: Wild Stewarded (non-timber forest product management systems in which wild non-timber forest product is harvested in a manner that demonstrates stewardship and sustainability). Forest Farmed (non-timber forest product management systems [e.g. woods-cultivated, woods-grown, virtually-wild, wildsimulated] in which intentional husbandry practices are used to produce a non-timber forest product in a forest environment). Is there anyone, other than the person(s) named above, who is authorized to discuss your operation with PCO? (This may be a spouse, employee, company representative or anyone else you designate): SECTION 2: Production and/or Harvest Areas Complete this table to detail each production/harvest site requested for verification. Useful factors in designating unique sites include considering areas that may have distinct planting dates, planned harvest dates, distinct management practices, similar ginseng densities throughout, and/or physical separation. In assigning site designations, keep in mind that the inspector will inspect each patch to verify the quantity of ginseng present. Attach additional sheets if needed. Estimated Site Estimated Yield Potential Do you Plan to Harvest Site Designation Average Plant Age Population as Green Root (lbs.) from this Site this Year? Yes No Unsure Yes No Unsure 1 PCO Forest Grown System Plan – American Ginseng V2, 04/22/2015 PCO Forest Grown System Plan - American Ginseng Yes Unsure Yes Unsure Yes Unsure Yes Unsure Yes Unsure Yes Unsure No No No No No No 1. Do you own the land used for each production/harvest site? Yes No If no, submit a signed Land Use Affidavit form or other documentation from the landowner giving you permission to use the land specified in your system plan. 2. A map detailing the location(s) and the size of the production/harvest site(s) must be submitted with this management plan. Include the patch designations given above to identify each unique patch on the map. Map Attached SECTION 3: Producer/Harvester Management Practices Select all options below that pertain to your operation and the sites of ginseng to be verified. 3. Site Establishment The forest farmed sites requested for verification were established using the following: Seed from cultivated parental stock Seed from wild parental stock Roots from cultivated parental stock Roots from wild parental stock Origin of planting stock unknown Known state of origin of planting stock (Specify): Other stand establishment/planting stock considerations (Specify): N/A – Only wild stewarded sites are requested for verification 4. Site Preparation and Maintenance The following methods are used to prepare and/or maintain the site: Tillage Excavation of grounds to modify slope Thinning of forest understory Thinning of forest canopy Use of raised beds Use of supplemental artificial shade Removal or clearing of rocks and other forest debris Other site preparation and maintenance practices: (Specify): N/A – No methods are used to prepare and/or maintain the site 5. Soil Fertility Management The following methods are used to manage soil fertility: Use of inputs originating from the forest production area (ex: leaf litter, mulch, etc.) Use of non-synthetic fertility inputs (ex: compost, manure, bone meal, gypsum, fish meal) Use of synthetic fertility inputs (ex: ammonium sulfate, calcium hydroxide) Other soil fertility management practices: (Specify): N/A – No methods are used to manage soil fertility 6. Pest, Weed, and Disease Management The following methods are used to manage pests, weeds, and diseases: Use of inputs originating from the forest production area (ex: leaf litter, mulch, etc.) Use of non-synthetic inputs (ex: beneficial bacteria/fungi, pyrethrum, vinegar, etc.) Use of synthetic inputs (ex: copper sulfate, hydrogen peroxide, insecticidal soaps, herbicidal soaps) Release of natural predators Removal of diseased plants Hand-weeding Low density plantings Intercropping Cultivation Hunting Fencing Water/Irrigation Management Use of Lures/Traps/Repellants/Baits Use of Plastic Mulch Other site preparation and maintenance practices (Specify): NA – No methods are used to manage pests, weeds, or diseases 2 PCO Forest Grown System Plan – American Ginseng V2, 04/22/2015 PCO Forest Grown System Plan - American Ginseng 7. Harvest Methods Ginseng is harvested in a continual manner and: Harvested seed is replanted in the area of the patch it was harvested from. Seed is replanted from other wild parental stock. Seed is replanted from cultivated parental stock. Seed is not replanted Entire sites of ginseng are harvested at a time and: Sites are replanted. Sites are not replanted Other harvesting methods (Specify): 8. Post-harvest Handling and Storage Plan Harvested roots are: Dried and stored from year to year Dried and sold in the same year of harvest Not dried and sold as green roots 9. Packaging Plan Harvested roots are: Packaged in retail containers (complete Forest Grown Product Profile) Packaged in bulk Not packaged 10. Marketing and State Certification Plan Ginseng is: Sold or marketed for use in the state of production Sold or marketed for export from the state of production and: Certified by applicant Certified by buyer Other marketing and certification plans (Specify): SECTION 4: Inputs 11. List inputs used or planned for use that originates from the forest production area (e.g. leaf biomass, wood chips): N/A 12. Complete the table below to detail each input used that does not originate from the forest production area. Attach additional sheets if needed. N/A – Inputs that do not originate from the forest production area are not used If an input is labeled for agricultural or forestry use, use of the material must not violate label instructions or restrictions. Use of inputs not originating from the forest production area must be consistent with Material Use Best Management Practices (Material use practices that are generally accepted by the scientific and professional community to be effective and practicable with minimal environmental impact), and documentation must be maintained to verify this. Input (Brand Name) Manufacturer Reason for Use EX: Champion WP Copper NuFarm Americas Fungicide to manage leaf blight EX: Gypsum United States Gypsum Manage soil fertility EX: Pyganic EC 5.0 II MGK Insect management 3 PCO Forest Grown System Plan – American Ginseng V2, 04/22/2015 PCO Forest Grown System Plan - American Ginseng SECTION 5: Processor/Handler Management Practices 13. List the products you are requesting for verification. In addition, you must complete a Product Profile for each product you are requesting for verification. 14. Describe the process used to produce and/or handle the above products or attach a product flow diagram: SECTION 6: Commingling 15. Describe the practices you use to prevent commingling of: a. Verified and non-verified products? b. N/A – All products are verified Wild stewarded and forest farmed ginseng root? N/A – All root is wild stewarded or all root is forest farmed SECTION 7: Recordkeeping 16. Describe your record keeping system, including the type of records you keep (e.g. planting records, input records, harvest records, storage records, production records, sales records): SECTION 8: Labeling 17. If product contains non-verified ingredients do you identify each verified ingredient with the words “PCO Forest Grown”, an asterisk or other reference mark on product labels? Yes No N/A – All ingredients are verified 18. Which of the follow seals do you use or plan to use? “PCO Forest Grown”: “Wild Stewarded”: “Forest Farmed”: 4 Color Color Color N/A – No seal used Black and White Black and White Black and White PCO Forest Grown System Plan – American Ginseng V2, 04/22/2015 PCO Forest Grown System Plan - American Ginseng SECTION 9: Affirmation I affirm that all statements made in the application are true and correct. I agree to comply with the standards and policies set forth by the Forest Grown Verification Program Manual, including but not limited to: 1. Establish, implement and update annually the Ginseng Management Plan that will be submitted to PCO. 2. Cooperate with the verification process by submitting all documentation requested by PCO. 3. Permit on-site inspection with complete access to all production and handling areas of my operation by PCO. These inspections may be announced or unannounced at the discretion of PCO. 4. Immediately notify PCO of any significant changes in my operation or portion of the operation that may affect compliance with the applicable standards. 5. Discontinue use of verification claims, PCO name and seal, upon revocation, surrender, or termination of verification and return or destroy any verification documents or materials requested by PCO. 6. Pay all fees as outlined on the most current fee schedule and be responsible for delinquent account fees, such as reasonable attorney fees, court costs and cost of collections. 7. Acknowledge that acceptance of this application in no way implies approval by PCO. I understand that failure to abide by the above requirements may result in non-approval, prosecution for fraud or misrepresentation, denial of services or any other remedy allowed by law. Your Signature(s): Date: Typing your name in the signature line above constitutes a signature. Submit this completed form with the following attachments, if applicable: Directions to harvest areas and/or facility Map detailing the location(s) and the size of the production/harvest site(s), including patch designations Completed Land Use Affidavit form(s) Facility map Product Profile(s) Product Label(s) Product Flow Diagram COST SHARE (for completion by applicant) Qualifications: PCO Verified Forest Grown applicant Cost-Share Scope: Application Fee for new producer/harvester applicants (first come first served, while funds last) Limit $200 per year per operation The funds will not cover: Sales assessment fees, Inspection fees, or Administrative fees for any new or existing operations Any fees for processor operations I affirm that I am eligible for the cost share, based on the below criteria, and wish to be considered for eligible reimbursement. I understand that cost share funds are limited, and are available on a first come, first serve basis. Your Signature(s): Date: Typing your name in the signature line above constitutes a signature. For Reviewer Use Only Is the application complete? Does the applicant appear to comply the standards? Yes Yes No No N/A Unsure, more info needed Comments: 5 PCO Forest Grown System Plan – American Ginseng V2, 04/22/2015