ST-3 Sample Submission Form - Hemp

U.S. DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE
Science & Technology Program
Laboratory Approval & Testing Division

National Science Laboratories
Sample Submission Form - Hemp

Complete the form, include a physical copy with the sample(s) and submit electronically to [email protected].
Contact the National Science Laboratories (NSL) at 704-867-3873 or email address above if assistance is needed to complete the form.
NSL LOCATION SAMPLES WILL BE SENT TO FOR ANALYSIS
NSL-GASTONIA, NC 801 Summit Crossing Place, Suite B, Gastonia, NC 28054
CONTACT INFORMATION FOR RESULTS

Customer Name
License ID

[As issued by USDA]

Primary Contact

Mailing Address

Contact Phone

City

Contact Email

State

Additional Email(s)

Zip Code

BILLING INFORMATION
Check if billing information is different than what is currently listed on the account and submit a revision to FORM ST-1 with the
new billing information. Contact NSL at 704-867-3873 or [email protected] for account information or assistance.
SAMPLE INFORMATION
Sample Description

Sample ID

# Items

[Insert (FSA) Lot Number]

Analysis Requested
[For example, THC only, cannabinoids, pesticide
residues, terpenes, heavy metals, mycotoxins]

Compliance Sample Test Type
[Select one]

SPECIAL INSTRUCTIONS AND INFORMATION
Sampling Agent ID [Required if requesting official compliance testing]
[Insert additional instructions and information as needed]

Special Instructions
According to the Paperwork Reduction Act of 1995, 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 0581-0251. The time required to complete this information collection is estimated to average 0.25 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. U.S. Department of Agriculture Non-Discrimination Statement: https://www.usda.gov/nondiscrimination-statement

OMB No. 0581-0251
Ver. 8/4/2023

https://www.ams.usda.gov/services/lab-testing/nsl

Form ST-3 (Reproduce Locally)