AD-13_SoilSamplingInformationSheet

Form AD-13 (March2010) SOIL SAMPLE INFORMATION — HEAVY METALS
SAMPLE TYPE
Heavy Metals Test ($25 per sample) NCDA&CS Agronomic Division Soil Testing Section
for regulated sites only — Mailing Address: 1040 Mail Service Center, Raleigh NC 27699-1040
not applicable for homeowners ! physical Address (UPS/FedEx): 4300 Reedy Creek Road, Raleigh NC 27607
Submit samples April 1-Dec 15 only. Phone: [phone] Web Address: www.ncagr.gov/agronomi
SAMPLE INFORMATION PAYMENT GROWER INFORMATION (please print)
FOR OFFICE USE ONLY
REPORT #
DATE REC'D
INITIAL
CONSULTANT/OTHER RECIPIENT
FARM ID
FEE TOTAL
AMT PAID
METHOD OF PAYMENT
( ) CASH
( ) CHECK
(payable to NCDA&CS)
( ) MONEY ORDER
( ) ESCROW (provide
account name below)
LAST NAME FIRST NAME
LAST NAME FIRST NAME
ADDRESS
--------------------------------
ADDRESS
---------------------------
SAMPLE DATE
CITY STATE ZIP
CITY STATE ZIP
COUNTY (where collected)
PHONE
PHONE
NUMBER OF SAMPLES
E-MAIL ADDRESS ❑ Do Not notify me when report is available.
E-MAIL ADDRESS ❑ Do Not notify me when report is available.
LAB NUMBER
(Leave blank)
SAMPLE
IDENTIFICATION
LIME APPLIED WITHIN
PAST 12 MONTHS
Tons/Acre Month Year
You must specify a crop CODE to receive a recommendation (see reverse side of form)
FIRST CROP
CODE
SECOND CROP
CODE
1
2
3
4
5
6
7
8
9
10
11
12
Thank you for using agronomic services to manage nutrients and safeguard environmental quality. — Steve Troxler, Commissioner of Agriculture

Taking a Soil Sample
-A SOiQ test is Odq as good as tke S01 SOWP,el
Use iron or stainless steel tools. Sample dry soil
in areas of 10 acres or fewer. Avoid combining
soils of different types and/or treatment histories.
Avoid fertilizer bands and corners or end -turn
areas. For each sample, collect 20 or more cores
at the appropriate depth (0-8" for plowed soils;
0-4" for no -till, sod & lawns). Mix cores in a
plastic bucket, then fill the sample box.
DO NOT PUT SOIL IN PLASTIC BAGS.
REQUIRED INFORMATION
The lab MUST have this information.
Filling out the Sample Information Form
w
J
a
LIME APPLIED WITHIN
LAB NUMBER
SAMPLE
PAST 12 MONTHS
FIRST CROP
CODE
SECOND CROP
CODE
I
(Leave blank)
IDENTIFICATION
Tons/Acre Month Year
1
J 1
1
9
2002
Cony
001
SKOR Gnaill
004 I
2
1
2
19
Nwen / Gnass, M
050
alQolren / Gloss, M
050
IS
12002
I
3
s 2
0
YFewudo, Ufa F_
043
Benwtuda Ala 044 I
,
,
SAMPLE & GROWER INFORMATION — Provide as much information as possible. Print neatly.
CONSULTANT/OTHER RECIPIENT — List name & contact information for anyone else who needs to know about the report.
SAMPLE IDENTIFICATION — Print an identifier (use numbers and/or letters) for each sample on a separate line. The identifier should
help remind you where the sample came from (Example: Jl, S1). Make sure the sample identifers on the boxes and on the information
form are the same. Use pencil or waterproof markers.
FIRST CROP — List the crop for which you want lime and fertilizer recommendations. Be sure to include the appropriate CODE from
the list below (e.g., Bermuda hay or pasture establishment, 043).
A. Use Lawn (code 026) for all lawn grasses except Centipede. Use one of the Fine Turf codes only for golf and athletic field turf
B. Use Shrubbery (code 029) for all shrubs, except azalea, camellia, rhododendron and mountain laurel.
C. For all home garden vegetables, use code 024.
LIME APPLIED WITHIN PAST 12 MONTHS — Provide the amount of lime applied in tons/acre, as well as the year and month of the last
DESIRABLE INFORMATION application, if made during the past 12 months. (50M is equivalent to one ton per acre.)
The lab can make better suggestions SECOND CROP — List the name of the crop that will follow the one listed as FIRST CROP. Include its CODE from the list below. This
if this information is provided. will enable us to make suggestions for this crop, assuming that the field is treated as suggested the first year. List the second crop even if
it will be grown the same year as FIRST CROP.
CROP CODES
E = establishment (1st year)
M = maintenance
SG = small grain
000 No Crop
Field Crops
001 Corn, grain
002 Corn, silage
003 Cotton
004 Small Grain
006 Milo (Grain Sorghum)
007 Peanut
010 Soybean
011 Sunflower
012 Tobacco, burley
013 Tobacco, flue -cured
014 Tobacco, greenhouse
015 SG silage/ Soybean
016 SG silage/ Corn silage
017 Kenaf
018 SG/ Soybean (double crop)
Home Lawn & Garden
020 Azalea
021 Camellia
022 Centipede
023 Flower garden
024 Vegetable garden
025 Mountain laurel
026 Lawn
027 Rhododendron
028 Rose
029 Shrubbery
030 Berries/ Fruit/ Nuts
031 Tree, shade
Christmas Trees
034 Leyland cypress
035 Line-out/ Seed Beds
036 Fir/ N Spruce/ Hemlock, E
037 Fir/ N Spruce/ Hemlock, M
038 Pine, White or Virginia
039 Blue Spruce/ Red Cedar
Foraae & Pasture
040 Alfalfa, E
041 Alfalfa, M
042 Common bermuda/ Bahia
Forage & Pasture (cont.)
043 Bermuda hay/ pasture, E
044 Bermuda hay/ pasture, M
047 Bluegrass pasture
048 Bluegrass/ White Clover
049 Clover/ Grass, E
050 Clover/ Grass, M
051 Gamagrass
053 Legumes, misc.
054 Fescue/ Orchard/ Timothy, E
055 Fescue/ Orchard/ Timothy, M
056 Prairiegrass
057 Switchgrass
059 Sudan/Sorghum/Millet/Red Crabgrass
060 Sudan/ Sorghum silage
Roadside Areas
061 Critical area
062 Roadside grass, E
063 Roadside grass, M
Wildlife Areas / Food Plots
066 Deer/Turkey
067 Upland game
068 Waterfowl
069 Fish pond
Commercial Hort Crops ONLY
[024 = all Home Vegetables]
070 Asparagus, E
071 Asparagus, M
072 Beans/ Peas
074 Beet
072 Beans/ Peas
074 Beet
075 Blueberry, E
076 Blueberry, M
077 Broccoli/ B. sprouts/Cauliflower
079 Cabbage
080 Cantaloupe/ Watermelon
084 Corn, sweet
085 Cucumber
088 Grape, E
089 Grape, M
090 Kale/ Mustard/ Spinach
093 Okra
095 Pea, southern
096 Pepper
097 Plant bed, vegetable
098 Potato, Irish
099 Sweetpotato
Commercial Hort Crops (cont.)
100 Radish
101 Rape/ Canola
102 Raspberry/ Blackberry, E
103 Raspberry/ Blackberry, M
107 Squash/ Pumpkin
108 Strawberry, E
109 Strawberry, M
110 Tomato
111 Tomato, greenhouse
115 Turnip
116 Vegetables, other
Commercial Nursery & Flowers
120 Dahlia
121 Gladiolus
122 Greenhouse
123 Gysophila (Baby's Breath)
124 Flower, bulbs
125 Flower, roots
126 Nursery, container
132 Rhododendron/ Ginseng/
Native ornamentals
136 Nursery/ Trees
Orchard. Fruit & Nut
130 Apple, E
131 Apple, M
138 Peach, E
139 Peach, M
140 Pecan, E
141 Pecan, M
Forest Trees & Seed
133 Hardwood, E
134 Hardwood, M
137 Nursery, pine
142 Pine, E
143 Pine, M
144 Hardwood, seed
145 Fir/ Spruce, seed
146 Pine, seed
Fine Turf
150 Fairway/ Athletic turf
151 Tee
152 Greens