Fillable Form AD-4 (2017): PLANT SAMPLE INFORMATION (Information Technology Services)

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Form AD-4 (2017): PLANT SAMPLE INFORMATION (Information Technology Services)

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Predictive ($5) Diagnostic ($5)
Research ($12) Out of State ($25)
Form AD-4 (2017)
PLANT SAMPLE INFORMATION
NCDA&CS Agronomic Division Plant/Waste/Solution/Media Section
Mailing Address: 1040 Mail Service Center, Raleigh NC 27699-1040
Physical Address (UPS/FedEx/DHS): 4300 Reedy Creek Rd, Raleigh NC 27607
Phone: (919) 733-2655 For lab results go to: www.ncagr.gov/agronomi
OFFICE USE ONLY
REPORT #
DATE REC’D
INITIAL





 !(W )
! 
 
 
" "
 
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(LEAVE BLANK)
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(Harvest
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.)/()()(-)(
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2/-)(6)#1.0(/* 2%%%%%%%%%%%
SAMPLE COMMENTS
Please provide informa*on to aid in recommenda*ons or diagnosis, such as fer*lizer
history, disease or insect presence, symptomology, etc.
_______________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
______________________________________________________________________
SAMPLE TYPE $0( &
SAMPLE INFORMATION PAYMENT GROWER INFORMATION (please write legibly) CONSULTANT / EXTENSION AGENT / OTHER
Thank you for using agronomic services to manage nutrients and safeguard environmental quality. — Steve Troxler, Commissioner of Agriculture
'(If known) '(If known)
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Diagnosc $/-(2*&))(1*=/*)(.-()..)*).0=00)*)*0))(1>0*,2
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Out of state ,).(/-A-1,B2)()
01).*)(*=)0)2)02).(())(.0,12).()C20((02).(C)20/12)
0((0
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/01.).(7D,C7ED,/,)).(C)7'E,B))02).(())!)! 2)(
.0)(F.*()C(1-/$&)02($(&F)))*)(7E.*()4/,0A))-1).())
(1-/4/,Brassicas$0)--)C<)(C).C-00(C/(./C0)/(GC0(()C/.&C.)02C)(,)(,)C).6))10)-)-1
0)2C020<C02.22):))0)H)EI'JC.)10)-)(2
1*,1.()2)/,2(A0+343/43403043
1)-1).(C(2/-,<02'<,-(0A).(C(2/-,<20.2)-)(1C-(C,/)
2)00/)<*)(,000)*.)).*(,())/--2.),)-1)0A).(
12)K1,0.C2)5!)2"%2...().)).((C).(2*6(!"%0/'@)-2((
))).2),)*C).(2(6)!56"%70))(C).(2)2"%73)82$-)00(1&3 !,$)..((1
,)).&
12=((10)1,harvest stage tobacco ()2(),).(C.0,1222()0((0,2"%3(()C"%3
"%3*).*,2.()
000
1
• !2 (!9:7( 59:7
• )!!:62)7:!))269*6!2287
• !!*6(!*6)7982) ((!2))()! 8)7
;2("%
."%
)),"%
)
0
)/),
(M)
Most Recent
Mature Leaf (M)
Pe*ole
Pe*ole only "%
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Completed 14 August 2020

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