PPQ 312 Pale Cyst Nematode

UNITED STATES DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
PLANT PROTECTION AND QUARANTINE

OMB APPROVED
0579-0322
EXP: XX/XXXX

PALE CYST NEMATODE SURVEY
PART 1: FINAL SURVEY DATA
1. FINAL DATE OF SURVEY

2. TOTAL NO. SAMPLES COLLECTED

1. STATE

2. COUNTY

3. NO. ACRES SURVEYED

PART 2: DATA ANALYSIS DIVISION

ID

3. TOTAL ACRES IN THE FIELD

20___

4. SITE NAME

5. NAME OF FARM

OPERATOR

6. MAILING ADDRESS

OWNER

PHONE

CITY

STATE

TRACT NUMBER

FIELD NUMBER(S)

ZIP CODE

7. SITE LOCATION
FSA NUMBER

8. TYPE OF SURVEY (Check only one. Fill out new form if other survey types exist for this location.)
Detection Field (DF)

Detection Field (DF) (Seed)

Commercial

Export

Export
9. SURVEY PATTERN
4x4

7x7

Delimiting Survey (DL) (Regulated)
Eradication Field (EF)

10. METHOD OF SURVEY
20m x 20m

12. CROP TYPE

11. LATITUDE & LONGITUDE

MANUAL

MECHANICAL

13. CROP STAGE
PREPLANT

Trace Forward (TF)

14. TOWNSHIP/RANGE/SECTION
PLANTED

POST HARVEST

PART 3: SURVEY DIVISION
1. DATA VERIFICATION: DATE AND INITIALS

2. DATE(S) GIVEN TO SURVEY TEAM

3. NAME OF TECHNICIAN/CREW LEAD
4. REMARKS (Describe any unique characteristics of the field or facility)

DATE

SAMPLES (ex. 30 total (1-30)

PERCENT
COMPLETE

COMMENT

CREW LEADER(S) (Please print your name along the line when this form is complete)
Paperwork Reduction Act: An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number.
The valid OMB control number for this information collection is 0579-0322. The time required to complete this information collection is estimated to average 1.25 hours per response, including the
time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

PPQ 312
JAN 2011