Organic System Plan Mushrooms

Organic System Plan Mushrooms Office Use Only Received: Fill out this form if you are requesting organic certification of mushrooms. A separate Organic System Plan Crops must be filled out if you are growing other organic crops for sale. Use additional sheets if necessary. If you are a new applicant, attach a completed General Information form. Section numbers refer to National Organic Program regulations (7 CFR, Part 205). SECTION 1: General Information 205.406(a)(2) First Name: MI: Last Name: Farm Name: Today s Date: Address: Phone: Fax: City: State: Zip code: E-mail: Website: List names, job titles & phone numbers of all persons authorized to discuss certification matters with PCO: Please check any of the following countries to which you intend to export organic mushrooms in the next 18 months: Canada European Union Taiwan Japan If you intend to export any of your organic products to Japan, Taiwan, the European Union or Canada, complete Section 12 of this form. SECTION 2: Organic Mushroom Operation Profile Complete the following table for all species of mushrooms requested for certification. Species of mushroom requested for certification Location Total area of this crop Projected yields SECTION 3: Spawn 205.204 1. Do you produce your own spawn or purchase it? 2. If you produce your own spawn, describe the process used and list all inputs: 3. If you purchase spawn, list name, address and phone number of suppliers: Page 1 of 8 CERT A09 OSP Mushrooms V2, R1, 1/22/13

4. Is purchased spawn certified organic? Yes No If not, submit documentation from the manufacturer stating that the spawn (including any supplements/additives) has been produced and handled without the use of genetic modification, ionizing, sewage sludge and synthetic materials not consistent with the National List. *If nonorganic spawn is used, you must have documentation from 3 sources indicating that organic spawn is not available. SECTION 4: Substrate 5. Do you purchase substrate or do you produce your own substrate? 205.203(c) If you purchase substrate, list the name and manufacturer on your Materials Used Form. 6. If you produce your own substrate, describe your substrate for each species of mushrooms. Include all substrate ingredients/materials and list the manufacturer names and contact information. Attach copies of labels for any chemicals or other materials added to the substrate: 7. How do you store your substrate materials? 8. Describe the procedure you use to prepare substrate for inoculation. For agaricus, describe Phase 1 and Phase 2 composting. For other mushrooms, describe pasteurization/sterilization procedure: SECTION 5: Crop Cycle 9. Explain the crop cycle from spawning to harvest: 205.201(a)(1) 10. List any log or spawn coatings used to prevent moisture loss: 11. How often are rooms emptied of mushroom substrate and cleaned? Page 2 of 8 CERT A09 OSP Mushrooms V2, R1, 1/22/13

SECTION 6: Storage 205.272 12. Describe your facilities (if any) for storing crops after harvest. Include size and capacity: 13. If both organic and non-organic crops are harvested and stored, describe methods used to prevent the risk of commingling: 14. Do you use any off-farm storage? Yes No If yes, describe off-farm storage and methods of segregation. Give locations and distance from the farm. SECTION 7: Water 15. What are your sources of water? On-site well Municipal River/creek/pond Spring Other (specify): 205.201(a)(6) 16. What is the date of your last water test for coliform bacteria and nitrates? 17. Were results satisfactory? Yes No 18. If you use additives in the water, please list them and attach copies of labels: No additives used 19. Do you add any chemicals to water used to soak shiitake or other logs? Yes No additives used If yes, list and attach copies of labels: 20. Describe your 21. irrigation system: 22. Is there any inherent or potential contamination from: Pesticide residues Heavy metals Nitrates Salinity Bacteria Petroleum Other (specify): Page 3 of 8 CERT A09 OSP Mushrooms V2, R1, 1/22/13

SECTION 8: Farm Management 205.201 and 205.206 A. MUSHROOM PESTS 23. Describe any problems with mushroom pests and methods of control: B. MUSHROOM DISEASES 24. Describe your significant problems with diseases and control methods: C. HARVEST 25. Describe harvest methods and include equipment used: D. CLEANING/SANITATION PRACTICES 26. Describe your cleaning/sanitation for all production sites and any equipment/surface that come into contact with organic product. Be sure to indicate whether the equipment/ surfaces are rinsed after cleaner or sanitizer use: *Include all cleaners/sanitizers on your Materials Used Form. E. QUALITY CONTROL 27. Describe your methods for grading and quality control: F. HANDLING & PACKING 28. Describe your methods to dry/cool, wash and pack crops. Include packing materials and post-harvest treatments: Page 4 of 8 CERT A09 OSP Mushrooms V2, R1, 1/22/13

G. LABELING 29. Do you use a label on products or packing materials? Yes No If yes, please attach a sample of each label. SECTION 9: Facility Pest Management 205.271 Complete this section to describe pest control practices and materials used in any facility where organic mushrooms are produced and/or stored. 30. What type of facility pest management system(s) do you use? In-house: name of responsible person: Contracted pest control service (name, phone no.): 31. Check all facility pest problems you generally have: Flying insects Crawling insects Spiders Birds Rats Mice Other(specify): 32. Check all facility pest management practices used. Note: All materials used for facility pest management must be listed on your Materials Used Form. Good sanitation Positive air pressure in facility Freezing treatments Removal of exterior habitat/food sources Cleanup of spilled product Mowing around outside buildings Physical barriers Monitoring devices Repair of holes, cracks, etc. Sticky traps Screened windows, vents, etc. Air curtains/air showers Nitrogen Ingredient inspection for pests Inspection zones around interior perimeter Electrocutors Ultrasound/light devices Release of beneficials Pheromone traps Mechanical traps Heat treatments Vacuum treatments Carbon dioxide Non-synthetic substances consistent with the National List (e.g. pyrethrum) Synthetic substance consistent with the National List (e.g. vitamin D3 bait) Synthetic substance NOT on the National List (e.g. most commercially available rodent bait Other (specify): 33. Describe monitoring, including frequency, used to determine effectiveness of management practices above: Attach facility map showing location of pest traps and monitoring devices. 34. If pest control materials are used where are they stored? Map Attached 35. What records do you maintain to document pesticide use and measures taken to prevent contamination of organic products and/or packaging materials? SECTION 10: Audit Trail Audit trail describes the ability to trace product from area of origin to the end user. 36. Which of the following documents do you maintain? Spawn purchase orders/invoices Applied Amendments Records Spray Record Invoices for Contracted Services Receipts for Inputs (fertilizers, pest controls, etc.) Employee Time Cards / Daily Activity Summaries Equipment Clean-out Logs Harvest & Storage Records for Certified Crops Clean Truck Affidavits Cull Reports Sales Invoices Bills of Lading Other (please list): 205.103 (a)(b) Page 5 of 8 CERT A09 OSP Mushrooms V2, R1, 1/22/13

37. How long do you maintain audit trail records? (Must be at least 5 years) 38. Can you trace the sale of crops back to their place (field, house, etc.) of origin? Yes No PRODUCT FLOW 39. Describe product flow in as much detail as necessary to provide the inspector with a sufficient understanding of your production system. Attach a product flow chart. SECTION 11: Marketing 205.303 40. Do you market your organic products? Yes No If yes, check all that apply: Farmers market Direct to retail CSA/subscription service On-farm retail Wholesale Wholesale to processor Contract to buyer Other (specify): 41. Labels must identify Pennsylvania Certified Organic as the certifying agent. a. Do you use or plan to use the PCO logo on the label? Yes No b. Do you intend to use the USDA logo on the label Yes No SECTION 12: International Export: Canada, European Union, Taiwan, Japan Please provide the following information even if you do not currently intend to export any organic products to Canada, European Union, Taiwan, or Japan in order for PCO to review this information. This will expedite any export verification needs you or your customers may have in the future. However, this information is not required for your Organic System Plan to be considered complete. A. CANADA N/A 42. Are any crops produced hydroponically or aeroponically? Yes No 43. Has Chilean nitrate (sodium nitrate) been used on any production areas? Yes No If Yes, in what field and on what date(s) was it applied? 44. Are you using any labels for products exported to Canada other than labels already approved by PCO? *Note: The 100% Organic Label is not permitted in Canada. Labels must be bilingual (English and French). Yes No N/A If yes, attach labels for PCO to review. Species of Mushrooms Requested to Ship to Canada Location Area Projected Yield to Export to Canada B. EUROPEAN UNION N/A 45. Are you using any labels for products exported to the European Union other than labels already approved by PCO? *Note: The 100% Organic Label is not permitted in the European Union. Yes No N/A If yes, attach labels for PCO to review. Species of Mushrooms Requested to Ship to the European Union Location Area Projected Yield to Export to the European Union Page 6 of 8 CERT A09 OSP Mushrooms V2, R1, 1/22/13

C. TAIWAN N/A 46. Are any mushrooms intended for export produced using any materials prohibited by the NOP National List? Yes If yes, list. No Species of Mushrooms Requested to Ship to Taiwan Location Area Projected Yield to Export to Taiwan D. JAPAN N/A 47. Does your facility use the following inputs in the products to be exported to Japan? a. Alkali-extracted humic acid? Yes No b. Lignin sulfonate (used as a flotation agent) Yes No Species of Mushrooms Requested to Ship to Japan Location Area Projected Yield to Export to Japan SECTION 13: Conflict of Interest 205.501 48. Have you used any organic production consultants for your operation in the last 12 months? Yes No (This does not refer to your inspector, certification specialist, or other PCO representative involved with your certification review.) If yes, list the name and contact information for organic consultant(s) your operation has used in the last 12 months (7 CFR 205.501 (a) (11) (ii): SECTION 14: Previous Organic Certification 205.401 49. List current organic certification by other agencies and dates: If currently certified by another agency, submit a copy of your current certificate and verification of the items you are certified to produce/sell. 50. If currently certified organic, has your operation received a non-compliance(s) or been issued a proposed suspension or proposed revocation that has not yet been resolved? Yes No If yes, submit a copy of any adverse action notice of non-compliance issued to you and a description of any actions taken by you to correct the non-compliance(s) noted in the including: notification of noncompliance, notification of proposed suspension or proposed revocation issued to you and a description of any actions taken by you to correct the non-compliance(s) notes in the adverse action notice, including evidence of such corrections an resolution letter from certifier, if any. 51. If previously certified, list names of agencies, dates, non-compliances and reasons for surrender or termination of certification: Page 7 of 8 CERT A09 OSP Mushrooms V2, R1, 1/22/13

\ Organic System Plan Mushrooms 52. Have you ever been denied organic certification or has your organic certification ever been withdrawn, surrendered suspended or revoked? Yes No If yes, submit a copy of any adverse action notice, including suspension, revocation or denial of certification issued to you and a description of any actions taken by you to correct the non-compliances noted in the notification, including evidence of such corrections and resolution letter from certifier or the National Organic Program Administrator, if any. If certification was withdrawn or surrendered, provide reason: 53. Gross organic sales of organic crops in previous calendar year: $ If none sold, enter 0. SECTION 15: Affirmation Information provided on this application is held in strict confidence and will be used only for certification purposes. I affirm that all statements made in this application are true and correct. To the best of my knowledge, no prohibited materials have been applied to any of my organically managed fields during the three-year period prior to projected harvest. I understand and agree as follows: 1. My operation may be subject to unannounced inspection and/or sampling for residues at any time as deemed appropriate to ensure compliance with the National Organic Program. 2. Acceptance of this questionnaire in no way implies granting of certification by the certifying agent. 3. Failure to comply with the applicable regulations, policies or procedures, or giving false information may result in denial, suspension, revocation or termination of certification. 4. Payment of all certification fees is a condition of certification. As required by the National Organic Program, and as conditions of certification I agree to: 1. Cooperate with the certification process by completing all documentation requested. 2. Make every effort to ensure that no prohibited products have been used, applied or otherwise allowed to compromise the integrity of the organic crops or products produced or sold by me. 3. Provide access to all areas and parts of my operation, including records, products and personnel. 4. Comply with the National Organic Program Rule (7 CFR Part 205) and Pennsylvania Certified Organic certification policies and procedures. 5. Make appropriate certification claims, which accurately reflect the type of certification granted 6. Ensure that my certificate or certification report is not used in a misleading manner and does not harm PCO. 7. Only use certification claims, or the PCO name and logo, to indicate that products are in compliance with PCO standards, and use them correctly on advertising, marketing and packaging materials. 8. Discontinue use of certification claims, and PCO name and logo, upon surrender, suspension, revocation or termination of certification, and return any certification documents or materials required by PCO. 9. Notify PCO of any significant changes to my operation s organic system plan. 10. Notify PCO concerning any application, including drift, of a prohibited substance to any field, production unit, site, facility, livestock, or product that is part of an operation. 11. Comply with all conditions of certification listed on Certification Reports or other certification documents. I understand that failure to abide by the above requirements may result in denial, suspension or revocation of my organic certification, prosecution for fraud or misrepresentation, denial of services, or any other remedy allowed by law. I give permission for PCO to release information from my file to other recognized certification organizations for purposes of document review. I understand that PCO will obtain a confidentiality statement from the requesting certifier before releasing any information. PCO has my permission to obtain information, documents, or materials related to certification or de-certification from other certifiers. Your signature(s): If applicable: Signature of Contracted Grower: Date: Date: Required attachments: These records must be returned with your application or it may be returned to you resulting in a delay of the certification process. General Information Form (if new applicant) Maps of the operation (including buildings/size, floor plan) Materials Used in Organic System - Crops Form Product Flow Chart from start to finish Labels used on your organic product(s) (if applicable) Page 8 of 8 CERT A09 OSP Mushrooms V2, R1, 1/22/13