Form CF.ACC.58 "Trichomoniasis Testing Submission Form" - Alabama

What Is Form CF.ACC.58?

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

Form Details:

  • Released on November 1, 2019;
  • The latest edition provided by the Alabama Department of Agriculture and Industries;
  • 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 CF.ACC.58 by clicking the link below or browse more documents and templates provided by the Alabama Department of Agriculture and Industries.

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Download Form CF.ACC.58 "Trichomoniasis Testing Submission Form" - Alabama

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Thompson Bishop Sparks
Accession #:
State Diagnostic Laboratory
Date:
890 Simms Road
Case
Auburn, AL 36832
Coordinator:
(334) 844-4987 Fax (334) 844-7224
 Charge
 N/C
 CA
 CK
Paid:
$
Trichomoniasis Testing Submission Form
 USPS
 UPS
 FedEx
 Other
Feedback Report
Submitted samples become the property of the laboratory
Other:
Veterinarian
Producer/Owner
Clinic
Business
License #
Account #
County
Premise ID
Address
Address
Phone
Phone
Fax
Fax
Email
Email
Report Format
Mail
Fax
Email
Report Format
Mail
Fax
Email
Submitted by:
Veterinarian
Producer/Owner
Other
Bill to:
Veterinarian
Producer/Owner
Other
∗∗∗∗
∗∗∗∗
Pooling Requested
Yes
No
To obtain Trich Media sample collection tubes, contact the diagnostic lab 334-844-7226. For sample submission, refer to the
instructions enclosed with the collection tubes. Enter animal identification one animal per line.
Sample
Sex
Age
Sample
Sex
Animal Identification
Animal Identification
Breed
Breed
Age
No.
M/F
No.
M/F
1
16
2
17
3
18
4
19
5
20
6
21
7
22
8
23
9
24
10
25
11
26
12
27
13
28
14
29
15
30
Print name __________________________Signature______________________________Date ____________
RESET
CF.ACC.58 TRICH FORM
TSG
November 2019
Page 1 of 3
Thompson Bishop Sparks
Accession #:
State Diagnostic Laboratory
Date:
890 Simms Road
Case
Auburn, AL 36832
Coordinator:
(334) 844-4987 Fax (334) 844-7224
 Charge
 N/C
 CA
 CK
Paid:
$
Trichomoniasis Testing Submission Form
 USPS
 UPS
 FedEx
 Other
Feedback Report
Submitted samples become the property of the laboratory
Other:
Veterinarian
Producer/Owner
Clinic
Business
License #
Account #
County
Premise ID
Address
Address
Phone
Phone
Fax
Fax
Email
Email
Report Format
Mail
Fax
Email
Report Format
Mail
Fax
Email
Submitted by:
Veterinarian
Producer/Owner
Other
Bill to:
Veterinarian
Producer/Owner
Other
∗∗∗∗
∗∗∗∗
Pooling Requested
Yes
No
To obtain Trich Media sample collection tubes, contact the diagnostic lab 334-844-7226. For sample submission, refer to the
instructions enclosed with the collection tubes. Enter animal identification one animal per line.
Sample
Sex
Age
Sample
Sex
Animal Identification
Animal Identification
Breed
Breed
Age
No.
M/F
No.
M/F
1
16
2
17
3
18
4
19
5
20
6
21
7
22
8
23
9
24
10
25
11
26
12
27
13
28
14
29
15
30
Print name __________________________Signature______________________________Date ____________
RESET
CF.ACC.58 TRICH FORM
TSG
November 2019
Page 1 of 3
Accession #
Page _____/______
Trichomoniasis Sample Continuation Sheet -- Print or Copy As Needed
Sample
Sex
Age
Sample
Sex
Animal Identification
Animal Identification
Breed
Breed
Age
No.
M/F
No.
M/F
RESET
CF.ACC.58 TRICH FORM
TSG
November 2019
Page 2 of 3
Accession #
Page _____/______
Trichomoniasis Sample Continuation Sheet -- Print or Copy As Needed
Sample
Sex
Age
Sample
Sex
Animal Identification
Animal Identification
Breed
Breed
Age
No.
M/F
No.
M/F
RESET
CF.ACC.58 TRICH FORM
TSG
November 2019
Page 3 of 3
Page of 3