Attachment_3_Seed_Analysis_Request_Form.pdf

ATTACHMENT 3

SEED ANALYSIS REQUEST FORM

This Attachment must be completed by the Contractor and Certified Sampler to provide Seed Testing Information to a seed laboratory as described in the Inspection and Acceptance Section of the Solicitation.

Contractor shall send this Seed Analysis request form with seed delivery to the BLM Regional Seed Warehouse after sample is taken. (With split samples, both seed and Attachment 3 Form are sent to Boise Regional Seed Warehouse.)

Spread Sheet ID# (SSID#) _______________________________

Species: ______________________________________________

Germplasm ID: ________________________________________

Vendor Name: ________________________________________

Vendor Lot Number: ___________________________________

Seed Lab Sent to: ______________________________________

Sampler Name: ________________________________________

Contractor: Please call each BLM office to coordinate which Tests need to be requested (rush, email, etc) from the seed labs. Please list pounds delivered to each location, check to indicate that a seed test will be sent to that location.

Seed Lab: Send seed test results to each of the offices receiving seed and checked.

CHARGE ALL SEED LAB TEST FEES TO THE BOISE REGIONAL SEED WAREHOUSE.

SEED LOT SAMPLE INFORMATION

Seed Lot Information Seed Quality Yes No Tests Requested

Total Pounds Seed Certified Purity X

Number of Bags Seed Non-Certified TZ X

Bag Size Seed Source Identified Noxious (all Western States) X

Number of Bags Sampled

Seed Source Origin

Rush

X

Date Sampled

Seed Treated?

100 Seed weight (Big sagebrush only)

X

Date Sample Sent to Lab

If treated please list type

E-mail X

Remarks: County/State: Elev: Other:

ATTACHMENT 3

Delivery Contact Send Test and Bill To: Bill To:

Boise Regional Seed Warehouse 1962 Commerce Avenue Boise, ID 83705

(208) 384‐3277 Office

(208) 384‐3324 Fax rgalvan@blm.gov dconn@blm.gov

Bureau of Land Management Attn: Ricardo Galvan Derek Conn Seed Warehouse Managers

Delivery/Purchaser Location Pounds Delivered Send Test To: Bill To:

Boise Regional Seed Warehouse Send Seed Test Results to Derek Conn and Rico Galvan

BRSW BRSW

Ely Regional Seed Warehouse Send Seed Test Results to Derek Conn and Rico Galvan

BRSW BRSW

Send Seed Tests and Billing to both Regional Seed Warehouse Managers:

Derek Conn dconn@blm.gov Phone: 208-384-3277 Fax: 208-384-3324 1962 Commerce Ave Boise, ID 83705

AND

Rico Galvan rgalvan@blm.gov Phone: 208-384-3277 Fax: 208-384-3324 1962 Commerce Ave Boise, ID 83705