Form FDACS-08400 "Specimen Submission Form" - Florida

Form FDACS-08400 is a Florida Department of Agriculture and Consumer Services form also known as the "Specimen Submission Form". The latest edition of the form was released in November 1, 2015 and is available for digital filing.

Download an up-to-date fillable Form FDACS-08400 in PDF-format down below or look it up on the Florida Department of Agriculture and Consumer Services Forms website.

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Download Form FDACS-08400 "Specimen Submission Form" - Florida

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Florida Department of Agriculture and Consumer Services
Division of Plant Industry
SPECIMEN SUBMISSION FORM
Section 581.031(14)(a), F.S. / Incorporated in Rule 5B-2.0011, F.A.C.
ADAM H. PUTNAM
COMMISSIONER
Referenced in Rule 5B-2.010, F.A.C.
Apiary Botany Entomology IFA Nematology Pathology
Priority:
Purpose:
Disposition:
(1) Urgent
(1) Quarantine
(1) Pin
(2) Routine
(2) Control
(2) Preserve
Log Number:
(3) Plant Problem
(3) Slide
(4) Survey
(4) Discard
Date Received:
(5) Academic
(5) Returned
(6) Certification
(6) Envelope
(7) Voucher
Host Plant Scientific Name:
Host Plant Common Name:
Diagnosis or Determination:
Date Collected:
Collector:
DPS #:
Date Sent:
Sender:
Owner, Nursery, Grove or Apiary Yard Name:
T
R
S
Address or Location of Specimen:
Nursery #:
City, State, Zip:
Block #:
County:
Country:
GPS Coordinates:
Lat.:
Long.:
Total Number of Plants Involved:
Total Acres Involved:
Total Number of Plants Affected:
Total Acres Affected:
Infection or
Part Involved:
Stage or
Collecting
Infestation Intensity:
Organism:
Technique:
(1) Bark
(8) Gall
(2) Flower
(9) Mine
(1) Egg
(1) Beating
(6) Multi-Lure
(1) Slight
(3) Fruit
(10) Litter
(2) Larva
(2) Black Light
(7) McPhail
(2) Moderate
(4) Leaves
(11) Soil
(3) Pupa
(3) Hand Catch
(8) Reared
(3) Severe
(5) Roots
(12) Other
(4) Adult
(4) Jackson
(9) Sticky Board
(6) Seed
(5) Nymph
CUE – ME - TML
(10) Sweeping
(7) Stem
(6) All Stages
(5) Lindgren
(11) Other
(7) Unknown
Funnel
Remarks:
Email Address(es) for Additional Reports:
Determiner:
Date Completed:
Recipient of Report:
FDACS-08400 Rev. 11/15
Page 1 of 2
Florida Department of Agriculture and Consumer Services
Division of Plant Industry
SPECIMEN SUBMISSION FORM
Section 581.031(14)(a), F.S. / Incorporated in Rule 5B-2.0011, F.A.C.
ADAM H. PUTNAM
COMMISSIONER
Referenced in Rule 5B-2.010, F.A.C.
Apiary Botany Entomology IFA Nematology Pathology
Priority:
Purpose:
Disposition:
(1) Urgent
(1) Quarantine
(1) Pin
(2) Routine
(2) Control
(2) Preserve
Log Number:
(3) Plant Problem
(3) Slide
(4) Survey
(4) Discard
Date Received:
(5) Academic
(5) Returned
(6) Certification
(6) Envelope
(7) Voucher
Host Plant Scientific Name:
Host Plant Common Name:
Diagnosis or Determination:
Date Collected:
Collector:
DPS #:
Date Sent:
Sender:
Owner, Nursery, Grove or Apiary Yard Name:
T
R
S
Address or Location of Specimen:
Nursery #:
City, State, Zip:
Block #:
County:
Country:
GPS Coordinates:
Lat.:
Long.:
Total Number of Plants Involved:
Total Acres Involved:
Total Number of Plants Affected:
Total Acres Affected:
Infection or
Part Involved:
Stage or
Collecting
Infestation Intensity:
Organism:
Technique:
(1) Bark
(8) Gall
(2) Flower
(9) Mine
(1) Egg
(1) Beating
(6) Multi-Lure
(1) Slight
(3) Fruit
(10) Litter
(2) Larva
(2) Black Light
(7) McPhail
(2) Moderate
(4) Leaves
(11) Soil
(3) Pupa
(3) Hand Catch
(8) Reared
(3) Severe
(5) Roots
(12) Other
(4) Adult
(4) Jackson
(9) Sticky Board
(6) Seed
(5) Nymph
CUE – ME - TML
(10) Sweeping
(7) Stem
(6) All Stages
(5) Lindgren
(11) Other
(7) Unknown
Funnel
Remarks:
Email Address(es) for Additional Reports:
Determiner:
Date Completed:
Recipient of Report:
FDACS-08400 Rev. 11/15
Page 1 of 2
NEMATODE CERTIFICATION FORM
AZ
SURVEY
Date:
CA
PLANT PROBLEM
Collector:
TX
BN BUFFER
LA
PIT
Owner, Nursery or Grove:
EU
SOIL FORMULATOR
PM
OTHER
SITE
Address or Location:
City:
Total Samples:
Accession
Collection
Number
Number
Host
Block
(Lab Only)
Remarks:
FDACS-08400 Rev. 11/15
Page 2 of 2
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