Form DPR-ENF-002 "Produce Sample Analysis Report" - California

What Is Form DPR-ENF-002?

This is a legal form that was released by the California Department of Pesticide Regulation - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 1, 2013;
  • The latest edition provided by the California Department of Pesticide Regulation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form DPR-ENF-002 by clicking the link below or browse more documents and templates provided by the California Department of Pesticide Regulation.

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Download Form DPR-ENF-002 "Produce Sample Analysis Report" - California

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STATE OF CALIFORNIA - DEPARTMENT OF PESTICIDE REGULATION / ENFORCEMENT BRANCH
PRODUCE SAMPLE ANALYSIS REPORT
DPR-ENF-002 (REV. 07/13) PAGE 1 OF 2
LABORATORY NUMBER
A. Type of Sample
QUARANTINE NUMBER
T-CASE NUMBER
ORIGINAL SAMPLE
OTHER (Specify)
FOLLOW-UP
B. Sample Site
CHAIN DISTRIBUTION
POINT OF ORIGIN
FARMERS MARKET
POINT OF ENTRY
PACKING SHED
ROADSIDE STAND
RETAIL
PROCESSING PLANT
OTHER (Specify)
WHOLESALE
C. Sample Location and Identity
COUNTY CODE WHERE SAMPLED
SAMPLE NUMBER
COMMODITY (Variety)
ORIGIN CODE
SAMPLE SIZE
LOT SIZE/CONTAINER QUANTITY
CONTAINER DESCRIPTION
LOT NUMBER/OTHER I.D. NUMBER
ORGANIC PRODUCE
BRAND NAME
YES
COLLECTION SITE (Name, Address, City, State, ZIP Code)
GROWER
(Name, Address, City, Telephone Number)
PACKER/SHIPPER
(Name, Address, City, Telephone Number)
DEALER/DISTRIBUTOR
(Name, Address, City, Telephone Number)
COMMENTS
SAMPLE COLLECTOR (PRINT NAME)
SIGNATURE
DUPLICATE SAMPLE
REQUESTED/
NOT REQUESTED
PROVIDED
DATE SAMPLED
TIME SAMPLED (AM/PM)
CONTACT PERSON - PLEASE PRINT LEGIBLY
TELEPHONE NUMBER (Include Area Code) REGIONAL OFFICE NO.
D. Chain of Custody (See page 2)
E. Laboratory Determination - Results relate only to the sample tested
(ADDITIONAL SPACE FOR ANALYSES ON PAGE 2)
AMOUNT
TOLERANCE
DET. LIMIT
DET. CODE*/
ANALYSIS REQUESTED
PESTICIDE DETECTED
EXT. CODE
(ppm)
(ppm)
(ppm)
ANALYST INITIALS
PESTICIDE SCREENS
LABORATORY NAME
CHEMIST'S SIGNATURE
DATE RECEIVED BY LAB.
LABORATORY ADDRESS
CONFIRMING CHEMIST'S SIGNATURE
DATE ANALYZED BY LAB.
QUALITY OF SAMPLE RECEIVED
SAMPLE DISCARD DATE
ACCEPTABLE
COMMENT:
E-MAIL
DATE
RESULTS FORWARDED TO
BY
VIA (Check One):
FAX
TIME
* Det. Code Key: 01 = GLC-ECD; 02 = GLC-FPD (Phosphorus Mode); 35 = GCMSMS; 52 = LCMSMS
MAIL
STATE OF CALIFORNIA - DEPARTMENT OF PESTICIDE REGULATION / ENFORCEMENT BRANCH
PRODUCE SAMPLE ANALYSIS REPORT
DPR-ENF-002 (REV. 07/13) PAGE 1 OF 2
LABORATORY NUMBER
A. Type of Sample
QUARANTINE NUMBER
T-CASE NUMBER
ORIGINAL SAMPLE
OTHER (Specify)
FOLLOW-UP
B. Sample Site
CHAIN DISTRIBUTION
POINT OF ORIGIN
FARMERS MARKET
POINT OF ENTRY
PACKING SHED
ROADSIDE STAND
RETAIL
PROCESSING PLANT
OTHER (Specify)
WHOLESALE
C. Sample Location and Identity
COUNTY CODE WHERE SAMPLED
SAMPLE NUMBER
COMMODITY (Variety)
ORIGIN CODE
SAMPLE SIZE
LOT SIZE/CONTAINER QUANTITY
CONTAINER DESCRIPTION
LOT NUMBER/OTHER I.D. NUMBER
ORGANIC PRODUCE
BRAND NAME
YES
COLLECTION SITE (Name, Address, City, State, ZIP Code)
GROWER
(Name, Address, City, Telephone Number)
PACKER/SHIPPER
(Name, Address, City, Telephone Number)
DEALER/DISTRIBUTOR
(Name, Address, City, Telephone Number)
COMMENTS
SAMPLE COLLECTOR (PRINT NAME)
SIGNATURE
DUPLICATE SAMPLE
REQUESTED/
NOT REQUESTED
PROVIDED
DATE SAMPLED
TIME SAMPLED (AM/PM)
CONTACT PERSON - PLEASE PRINT LEGIBLY
TELEPHONE NUMBER (Include Area Code) REGIONAL OFFICE NO.
D. Chain of Custody (See page 2)
E. Laboratory Determination - Results relate only to the sample tested
(ADDITIONAL SPACE FOR ANALYSES ON PAGE 2)
AMOUNT
TOLERANCE
DET. LIMIT
DET. CODE*/
ANALYSIS REQUESTED
PESTICIDE DETECTED
EXT. CODE
(ppm)
(ppm)
(ppm)
ANALYST INITIALS
PESTICIDE SCREENS
LABORATORY NAME
CHEMIST'S SIGNATURE
DATE RECEIVED BY LAB.
LABORATORY ADDRESS
CONFIRMING CHEMIST'S SIGNATURE
DATE ANALYZED BY LAB.
QUALITY OF SAMPLE RECEIVED
SAMPLE DISCARD DATE
ACCEPTABLE
COMMENT:
E-MAIL
DATE
RESULTS FORWARDED TO
BY
VIA (Check One):
FAX
TIME
* Det. Code Key: 01 = GLC-ECD; 02 = GLC-FPD (Phosphorus Mode); 35 = GCMSMS; 52 = LCMSMS
MAIL
STATE OF CALIFORNIA - DEPARTMENT OF PESTICIDE REGULATION / ENFORCEMENT BRANCH
PRODUCE SAMPLE ANALYSIS REPORT
DPR-ENF-002 (REV. 07/13) PAGE 2 OF 2
LABORATORY NUMBER
SAMPLE NUMBER
D. Chain of Custody (Please sign)
RECEIVED FROM (Sample Collector)
DATE
REASON
DELIVERED TO (PERSON)
TIME (AM/PM)
SAMPLE RECEIVED BY
REASON
DELIVERED TO (PERSON)
DATE
TIME (AM/PM)
SAMPLE RECEIVED BY
DELIVERED TO (PERSON)
TIME (AM/PM)
DATE
REASON
SAMPLE RECEIVED BY
REASON
DELIVERED TO (PERSON)
DATE
TIME (AM/PM)
SAMPLE RECEIVED BY
DELIVERED TO (PERSON)
TIME (AM/PM)
DATE
REASON
SAMPLE RECEIVED BY
DELIVERED TO (PERSON)
TIME (AM/PM)
REASON
DATE
E. Laboratory Determination - Results relate only to the sample tested (Continued from page 1)
AMOUNT
TOLERANCE
DET. LIMIT
DET. CODE*/
PESTICIDE DETECTED
EXT. CODE
(ppm)
(ppm)
(ppm)
ANALYST INITIALS
ADDITIONAL COMMENTS
* Det. Code Key: 01 = GLC-ECD; 02 = GLC-FPD (Phosphorus Mode); 35 = GCMSMS; 52 = LCMSMS
Page of 2