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DRAFT FDACS-08113 10/19 Florida Department of Agriculture and Consumer Services Division of Plant Industry HEMP SAMPLE SUBMISSION FORM Section 581.217, F.S., 5B-57.014 F.A.C Post Office Box 147100, Gainesville, FL 32614-7100 / (352)395-4700 This form is to be submitted with each composite hemp sample collected for THC analysis. A separate form is required for each composite sample. Sampling must be done in accordance with Rule 5B.57.014(7), F.A.C. The licensee must require the laboratory to report the analysis results for Total delta-9 tetrahydrocannabinol concentration and send a copy of this form directly to the Department by email at [email protected] within twenty-four (24) hours of test completion. License Number: Date Sample Collected: Collector: Date Sample Submitted to Lab: Plot Planting Date: Anticipated Harvest Date: Responsible Person Information: Name: First Middle Last Address: Street or PO Box City State Zip Code Email Address: Phone: Variety and Growing Location: Plot designation: Variety: Growing Address: Street or Parcel Number or GPS City State Zip Code Acreage or Square Footage Sampled: Plot size Number of plant clippings for each composite sample ≤ 50 acres 5 (one from each quadrant and one from the center of the Plot) > 50 acres but ≤ 100 acres 10 (two from each quadrant and two from the center of the Plot) > 100 acres but ≤ 500 acres 15 (three from each quadrant and 3 from the center of the Plot) > 500 acres 20 (four from each quadrant and four from the center of the Plot) Number of clippings included in this composite sample: Remarks: Responsible Person Signature: Lab Receiver Signature: Date: NICOLE “NIKKI” FRIED COMMISSIONER
