Form C43130530 "Request for Plant Disease Diagnostics" - Prince Edward Island, Canada

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Download Form C43130530 "Request for Plant Disease Diagnostics" - Prince Edward Island, Canada

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Agriculture & Land
PEI Analytical Laboratories
Request for Plant
23 Innovation Way
Disease Diagnostics
Charlottetown, PE C1E 0B7
Telephone: (902) 620-3300
Client Information
GROWER NAME
PHONE NO.
SUBMITTED BY
PHONE/CELLULAR
FARM NAME
FAX NO.
COMPANY NAME
FAX NO.
ADDRESS
ADDRESS
EMAIL
EMAIL
DIAGNOSTIC REPORT TO BE SENT TO
Sample Details
□
□
□
SAMPLE COLLECTION SITE
Field
Storage
Other (please specify)
□
□
□
□
□
SAMPLE TYPE
Whole Plant
Branches
Leaves
Tuber
Other (please specify)
CROP
VARIETY
SEED SOURCE/CLASS
PREVIOUS CROP
PLANTING/HARVEST DATE
COLLECTION DATE
DATE WHEN SYMPTOMS APPEARED
% OF CROP AFFECTED
□
□
□
□
□
□
SEVERITY OF SYMPTOMS
Slight
Moderate
Severe
DRAINAGE
Good
Fair
Poor
□
□
□
□
□
□
FIELD/STORAGE LOCATION
Whole Crop
Random
Localized
Edge of Field
Few Rows
High/Dry Area
□
□
□
□
Low/Wet Area
Sunny Area
Shady Area
Other (please specify)
PRODUCTS USED – FIELD/STORAGE
APPLICATION DETAILS
DESCRIPTION OF SYMPTOMS
For Lab Use Only
Date Rec:
Time Rec:
Staff Signature:
Personal information on this form is collected under section 31 © of the Freedom of Information and Protection of Privacy Act R.S.P.E.I. 1988, c. F-
15.01 as it relates directly to and is necessary for a request of plant disease diagnosis and will be used for the purpose of contacting the client, and
maintaining departmental records. This information may be shared with CFIA for samples which are suspected to contain disease which require
quarantine. If you have any questions about this collection of personal information, you may contact the PEI Analytical Laboratories at 620-3300 and
speak with the Lab Manager.
www.princeedwardisland.ca/labservices
Visit our homepage:
C43130530 (May 2019)
Agriculture & Land
PEI Analytical Laboratories
Request for Plant
23 Innovation Way
Disease Diagnostics
Charlottetown, PE C1E 0B7
Telephone: (902) 620-3300
Client Information
GROWER NAME
PHONE NO.
SUBMITTED BY
PHONE/CELLULAR
FARM NAME
FAX NO.
COMPANY NAME
FAX NO.
ADDRESS
ADDRESS
EMAIL
EMAIL
DIAGNOSTIC REPORT TO BE SENT TO
Sample Details
□
□
□
SAMPLE COLLECTION SITE
Field
Storage
Other (please specify)
□
□
□
□
□
SAMPLE TYPE
Whole Plant
Branches
Leaves
Tuber
Other (please specify)
CROP
VARIETY
SEED SOURCE/CLASS
PREVIOUS CROP
PLANTING/HARVEST DATE
COLLECTION DATE
DATE WHEN SYMPTOMS APPEARED
% OF CROP AFFECTED
□
□
□
□
□
□
SEVERITY OF SYMPTOMS
Slight
Moderate
Severe
DRAINAGE
Good
Fair
Poor
□
□
□
□
□
□
FIELD/STORAGE LOCATION
Whole Crop
Random
Localized
Edge of Field
Few Rows
High/Dry Area
□
□
□
□
Low/Wet Area
Sunny Area
Shady Area
Other (please specify)
PRODUCTS USED – FIELD/STORAGE
APPLICATION DETAILS
DESCRIPTION OF SYMPTOMS
For Lab Use Only
Date Rec:
Time Rec:
Staff Signature:
Personal information on this form is collected under section 31 © of the Freedom of Information and Protection of Privacy Act R.S.P.E.I. 1988, c. F-
15.01 as it relates directly to and is necessary for a request of plant disease diagnosis and will be used for the purpose of contacting the client, and
maintaining departmental records. This information may be shared with CFIA for samples which are suspected to contain disease which require
quarantine. If you have any questions about this collection of personal information, you may contact the PEI Analytical Laboratories at 620-3300 and
speak with the Lab Manager.
www.princeedwardisland.ca/labservices
Visit our homepage:
C43130530 (May 2019)
SAMPLE COLLECTION, PACKAGING AND SUBMISSION
1.
Samples submitted to the lab must be representative of the symptoms observed in the field.
2.
Specimens must be fresh. Do not submit dead tissue.
3.
Samples should be packaged to prevent contamination during transport. Proper packaging may
include a combination of layering with damp paper toweling, use of paper bags or enclosure in a
plastic bag. Contact the lab for direction if uncertain.
4.
If a sample cannot be transported immediately, keep refrigerated and out of direct sunlight.
5.
Fill out the sample submission form with as much detail as possible. Sample forms should
accompany the sample and be packaged so there is no contact with the sample.
6.
Samples may be dropped off directly at the PEI Analytical Laboratory location, or at any access site
according to the schedule below.
Sample Drop-off Sites
Access PEI Site
Monday
Tuesday
Wednesday
Thursday
Friday
O’Leary
●
●
●
●
●
Tignish
●
Alberton
●
Wellington
●
Summerside
●
●
●
●
●
Souris
●
●
●
•
•
Montague
●
●
●
PEI Analytical Laboratory
●
●
●
●
●
(23 Innovation Way, Charlottetown)
Samples must be delivered to an Access PEI site prior to 3:00 p.m. (12 noon on Fridays).
Check reverse side for drop-off sites near you.
Failure to recover or identify disease in a sample does not imply that a field or commodity represented
by the sample is free of the organism. Due to uneven distribution and/or seasonal fluctuations of the
disease and limitations of sampling procedures used, PEI Analytical Laboratory does not guarantee or
imply as a result of a negative test result, freedom in the population from which the sample was
withdrawn.
www.princeedwardisland.ca/labservices
Visit our homepage:
C43130530 (May 2019)
Prince Edward Island Department of Agriculture and Land Prince Edward Island Legal Forms Canada Legal Forms

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