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
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(LEAVE BLANK)
(M, W, T,
E, H, P)
(Harvest
tobacco only)
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GROWING CONDITIONS (CHECK ALL THAT APPLY)
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SAMPLE COMMENTS
Please provide informa*on to aid in recommenda*ons or diagnosis, such as fer*lizer
history, disease or insect presence, symptomology, etc.
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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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