Fillable SOIL SAMPLE SUBMISSION FORM - (Information Technology Services)

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SOIL SAMPLE SUBMISSION FORM - (Information Technology Services)

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SOIL SAMPLE SUBMISSION FORM -
NCDA&CS Agronomic Division Soil Testing Section
-

-


’

FARM ID (oponal)
SAMPLING DATE (oponal)
SAMPLE METHOD
□ GPS Grid
□ Management Zone
COUNTY 
NUMBER OF SAMPLES
LAST NAME FIRST NAME LAST NAME FIRST NAME
ADDRESS ADDRESS
CITY STATE ZIP CITY STATE ZIP
EMAIL ADDRESS (REQUIRED) EMAIL ADDRESS
PHONE
(______) ___________________
PHONE
(______) ____________________
FEE TOTAL $_______________
AMT PAID $ _______________
METHOD OF PAYMENT:
□ CASH / CHECK
□
INVOICE
○ Grower
○ Advisor / Consultant
○ ____________
□
ESCROW ACCOUNT:
(provide Account Name or Number)
_________________________
“Reports will appear as “Pay Now”
unl Payment is applied”
LAB NUMBER (LEAVE BLANK) SAMPLE ID

LIME APPLIED WITHIN
PAST 12 MONTHS
Tons/Acre Month Year
FIRST CROP
CROP
CODE
(see side 2)
SECOND CROP
CROP
CODE
(see side 2)
1
2
3
4
5
6
7
8
9
10
ROUTINE / PREDICTIVE SAMPLES
SAMPLE INFORMATION PAYMENT GROWER INFORMATION (please print legibly) AGENT OR ADVISOR
Thank you for using agronomic services to manage nutrients and safeguard environmental quality. — Steve Troxler, Commissioner of Agriculture
PALS # 
   
PALS # 
   
By submitting this form to the NCDA&CS Agronomic Division, I attest that the accompanying samples were collected in North Carolina.
Samples cannot be received without necessary paperwork. Use NCDA&CS sample boxes only. Bags from other labs are not accepted.
✔
1. Use iron or stainless steel probes/tools & a clean plasc
bucket.
2. Avoid combining areas of dierent soil types & ferlizer
histories; avoid ferlizer bands, & corners / ends of elds.
3. Collect 15 to 20 cores per sample; sample 0 to 8 inches
deep for plowed elds; 0 to 4 inches deep for no-ll or
pastures.
4. Break up cores & mix soil in bucket.
5. Use pencil or waterproof markers on boxes and forms.
6. Label soil box with name, address, and sample IDs.
7. Fill the sample box to red ll line; please do not overll.
8. DO NOT PUT SOIL IN PLASTIC BAGS. DO NOT TAPE BOXES.
9. Lime history is important; be sure to record lime applied in
the past 12 months on page 1.
10. Crop codes are needed to receive a recommendaon;
samples cannot be processed without a crop code.
11. Ship samples in a well packed cardboard box so samples
are ghtly secured from within. Do not ship samples using
at mailers or envelopes.
Helpful Tips on Soil Sampling
Crop Codes for Commercial Producon
Homeowner Form (hp://www.ncagr.gov/agronomi/documents/FormAD-15_corrected_logo.pdf)
Field Crops
001 Corn, grain
002 Corn, silage
003 Coon
004 Small Grain (SG)
005 Millet, pearl
006 Grain Sorghum
007 Peanut
008 Rice
009 Sorghum, syrup
010 Soybean
011 Sunower
012 Tobacco, burley
013 Tobacco, ue-cured
015 SG silage / Soybean
016 SG silage / Corn silage
018 SG/Soybean (double crop)
Forage and Pasture
040 Alfalfa, E
041 Alfalfa, M
042 Common Bermuda /Bahia
043 Bermuda hay/pasture , E
044 Bermuda, hay/ pasture M
047 Bluegrass
048 Bluegrass/White Clover
049 Clover/Grass, E
050 Clover/Grass, M
051 Gamagrass
053 Legumes, various
054 Fescue/Orch/Timothy, E
055 Fescue/Orch/Timothy, M
056 Prairiegrass
057 Switchgrass
059 Sudan/Sorghum pasture
060 Sudan/Sorghum silage
Christmas Trees
034 Leyland Cypress
035 Line-out/Seed beds
036 Fir/N.Spruce/Hem, E
037 Fir/N.Spruce/Hem, M
038 White/VA Pine
039 Blue Spruce/Red Cedar
Abbreviaons
E = establishment (1
st
year)
M= Maintenance
SG = small grain
Wildlife Food Plots
066 Deer/Turkey
067 Upland Game
068 Waterfowl
069 Fish Pond
Specialty Crops
101 Canola / Rape
301 Clary Sage
310 Hemp
119 Hops
017 Kenaf
311 Trues
070 Asparagus, E
071 Asparagus, M
072 Beans/Peas
073 Beans, Pole
074 Beet
075 Blueberry, E
076 Blueberry, M
077 Brocc/BSprouts/Caul
079 Cabbage
080 Cantalope/Melons
084 Corn, Sweet
085 Cucumber
088 Grape, E
089 Grape, M
175 Grape, Vinifera
090 Kale/Mustard/Spinach
093 Okra
095 Pea, Southern
096 Pepper
097 Plant bed, vegetables
098 Potato, Irish
099 Sweetpotato
100 Radish
102 Black/Raspberry, E
103 Black/Raspberry, M
107 Squash/Pumpkin
108 Strawberry, E
109 Strawberry, M
118 Strawberry, plasc
110 Tomato
111 Tomato, greenhouse
115 Turnip
116 Vegetables, other
Commercial Horcultural Crops
Commercial Turf &
Sod Producon
150 Fairway/Athlec Field
151 Tee
152 Greens
153 Cenpedegrass
154 Hybrid Bermudagrass
155 St. Augusnegrass
156 Tall Fescue
157 Zoysiagrass
Commercial Nursery
& Flowers
120 Dahlia
121 Gladiolus
123 Gypsophila (baby’s breath)
124 Flowers, bulbs
125 Flower, roots
126 Container, nursery
132 Rhod/Ginseng/Naves
136 Tree nursery
Orchard, Fruit
& Nut
130 Apple, E
131 Apple, M
138 Peach, E
139 Peach, M
140 Pecan, E
141 Pecan, M
Forestry
133 Hardwood, E
134 Harwood, M
137 Pine, nursery
142 Pine, E
143 Pine, M
144 Hardwood, seed
145 Fir/Spruce, seed
146 Pine, seed
Stormwater
200 Bioretenon cell
Roadside Areas
061 Crical area
062 Grass, E
063 Grass, M
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SOIL SAMPLE SUBMISSION FORM - (Information Technology Services)

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Completed 28 January 2021

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