Seed Sample Identification Form For Certification
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1Form D
Office use only
Date to lab: ________________
Seed Sample Identification Form for Certification
Lab ID number: _____________
Logged in by: _______________
Colorado Seed Growers Association
Phone #
IMPORTANT:
Applicant
This form is for samples from Certified
Production Fields or Conditioned Seed
Grower (if different from applicant)
Lots ONLY.
It is the sender’s responsibility to fill
Crop
Variety
out all necessary parts to assure
proper handling and identification of
the sample it accompanies.
CSGA Field Number(s)
Year Produced
Incomplete forms will not be
processed. Signature is required for
processing.*
Applicant’s Lot or ID Number
Lab Tests Requested (select ALL that apply)
Purity w/ Noxious Germination Clearfield® Confirm KOH
Seed Count
Other
‐OR choose‐
Complete
ALL
(This includes
tests required for certification for this sample, with no exceptions or substitutions)
Treated Seed
No
Yes, with
Cleaned Seed
This sample is representative of
lbs
bu of cleaned seed intended for final certification by the
Colorado Seed Growers Association. This is not a certification certificate. Certification will be issued upon approval.
CSGA Approved Conditioner
Date (mo/yr) Cleaned
Bin Run Seed
This sample is representative of
lbs
bu of un‐cleaned seed, and not eligible for certification at this time.
I understand that it must be cleaned by an approved conditioner to be considered for certification.
* I declare that all of the information provided is accurate and I understand that
I am responsible for all fees associated with the testing of this seed sample.
Signed: _____________________________________________________ Date: ____________________________
** Please send 2 copies of this form with your seed sample and keep a copy for your records **
Send samples to:
Drop them off
Colorado Seed Laboratory
‐OR‐
Department of Soil & crop Sciences, CSU
224 Shepardson Building, CSU
Campus Delivery 1170
Fort Collins, Colorado
Fort Collins, CO 80523‐1170
Colorado Seed Lab Phone: 970‐491‐6406
Colroado Seed Growers Phone: 970‐491‐6202
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