Download Specimen Information Form - Department of Plant Pathology and

Lab Specimen No.
Specimen Information Form
Plant Disease Clinic, Department of Plant Pathology
220 Buckhout Laboratory
Please Complete All Sections of this Form
University Park, PA 16802
Client Information
Name
Address
City, State, Zip
County
Phone
Fax
E-Mail
Submitter information
Cooperative Extension Office for Commercial Grower/Company
Cooperative Extension Office for Homeowner
Homeowner
Commercial Grower/Company
Certified Organic
Specimen Information
Plant
Variety
Date Collected
Describe the problem and explain what concerns you:
Plant Part Affected
Leaves
Roots
Stems, branches
Flowers
Type of Planting
Garden
Yard
Indoor/house
Field
Forest
Greenhouse
Other:
Soil Type
Sandy
Clay
Loam
Symptoms
Yellowing:
Browning:
Wilting
Other:
Nursery
Orchard
Plantation
Vineyard
Golf course
High Tunnel
Soil Moisture
Excessive
Adequate
Deficient
___ Interveinal
___ Interveinal
Distortion
Disease Distribution
General
Scattered plants
Dry areas
Wet areas
Shaded areas
Sunny areas
Other:
Drainage
Good
Moderate
Poor
___ General
___ General
Mottling
___ Marginal
___ Marginal
Leaf Spots
High areas
Low areas
Foundation
Next to drive or road
Near vents/fans
End/Edge of planting
Terrain
Sloped
Level
Low
When did the symptoms first appear?
please continue on page 2
page 2
When?
Has the problem occurred before?
Acres
Number of plants
Size of Planting
Extent of Problem
Percentage of plants affected or
Number of plants affected
Previous Crop (name):
Trees/Shrubs:
Approximate age:
Height:
How long has the plant been growing in the present site?
Treatments Applied This Season and Previous Year:
Disturbances
High winds
Hail recently
Frost
(Fertilizer, Fungicide, Insecticide, Herbicide, Other)
Excavation, ______ ft away
Construction nearby
Gas or sewer lines
Other:
None
Turfgrass: If sample is turfgrass, please describe the infection center:
Grass killed
Grass thinned
No distinct pattern; irregular areas
Definite pattern to affected areas:
Circular areas
Size
Rings
Size
Size of affected area:
Greenhouse Specimens: If sample is a greenhouse specimen, please complete the following:
Raised beds
Heating system:
Ground beds
Irrigation system:
Pots or containers
Soil mixture:
Growth regulators applied (list materials and date):
Fertilizer used (list type and analysis):
Fertilizer application technique:
soil incorporation
foliar spray
Temperature in production area:
Days:
to
dry on surface
F
Nights:
Additional Comments:
Diagnostic Lab Use Only:
Sample Condition
February 2011
Information Received
Photo or digital image
liquid on surface
to
F