BBy submitting this form to the NCDA&CS …

1 For laboratory results, go to laboratory results, go to INFORMATIONPAYMENTGROWER INFORMATION (please print legibly)CONSULTANT/OTHER RECIPIENTFARM ID (optional)FEE TOTAL _____METHOD OF PAYMENTESCROW ACCOUNT ONLY (write account name below)_____LAST NAME FIRST NAME LAST NAME FIRST NAME ADDRESS ((in where samples were collectedin where samples were collected))ADDRESSSAMPLE DATE (optional)CITY STATE ZIP NCCITY STATE ZIPNC COUNTY (where collected)RemindersUse NCDA&CS sample boxes only.

2 Fill to red line. Bags not crop code(s) from list on back of ADDRESS E-MAIL ADDRESS NUMBER OF SAMPLESPHONE PALS # ___ ___ ___ ___ ___ ___(if known)PHONE PALS # ___ ___ ___ ___ ___ ___(if known) By submitting this form to the NCDA&CS Agronomic Division, I attest that the accompanying samples were collected in North submitting this form to the NCDA&CS Agronomic Division, I attest that the accompanying samples were collected in North NUMBER(Leave blank)SAMPLE IDENTIFICATION LIME APPLIED WITHINPAST 12 MONTHS Tons/Acre Month YearYou must specify a crop CODE to receive a recommendation (see reverse side of form )FIRST CROPCODESECOND CROPCODE12345678910 NCDA&CS Agronomic Division Soil Testing SectionMailing Address: 1040 Mail Service Center, Raleigh NC 27699-1040 Physical Address (UPS/FedEx): 4300 Reedy Creek Road, Raleigh NC 27607 Phone: (919) 733-2655 Website: SAMPLE INFORMATION Soil Soil OnlyROUTINE/PREDICTIVE SAMPLES April ~ Thanksgiving.

3 No feeDecember March: $4 / sampleCheck online for exact AD-1 (April 2015)Thank you for using agronomic services to manage nutrients and safeguard environmental quality. Steve Troxler, Commissioner of AgricultureTaking a Soil Sample A soil test is only as good as the soil sample!Use iron or stainless steel tools. Sample dry soil in areas of 10 acres or fewer. Avoid combining soils of different types and/or treatment histories. Avoid fertilizer bands and corners or end-turn areas. For each sample, collect 15 20 cores at the appropriate depth (0 8" for plowed soils; 0 4" for no-till, sod & lawns).

4 Mix cores in a plastic bucket, then fi ll the sample box. DO NOT PUT SOIL IN PLASTIC out the Sample Information form SAMPLE & GROWER INFORMATION Provide as much information as possible. Print INFORMATIONThe lab MUST have this INFORMATIONThe lab can make better suggestions if this information is RECIPIENT List name & contact information for anyone else who needs to know about the IDENTIFICATION Print an identifi er (use numbers and/or letters) for each sample on a separate line. The identifi er should help remind you where the sample came from (Example: J1, S1).

5 Make sure the sample identifers on the boxes and on the information form are the same. Use pencil or waterproof markers. FIRST CROP List the crop for which you want lime and fertilizer recommendations. Be sure to include the appropriate CODE from the list below ( , Bermuda hay or pasture establishment, 043). A. Use Lawn (code 026) for all lawn grasses except Centipede. Use one of the Fine Turf codes only for golf and athletic fi eld turf. B. Use Shrubs (code 029) for all shrubs, except azalea, camellia, rhododendron and mountain laurel. C. For all home garden vegetables, use code APPLIED WITHIN PAST 12 MONTHS Provide the amount of lime applied in tons/acre, as well as the year and month of the last application, if made during the past 12 months.

6 (50M = 50 lb/1000 ft2, which is equivalent to one ton per acre.)SECOND CROP List the name of the crop that will follow the one listed as FIRST CROP. Include its CODE from the list below. this will enable us to make suggestions for this crop, assuming that the fi eld is treated as suggested the fi rst year. List the second crop even if it will be grown the same year as FIRST NUMBER(Leave blank)SAMPLEIDENTIFICATIONLIME APPLIED WITHINPAST 12 MONTHSTons/Acre Month YearFIRST CROPCODESECOND CROPCODE1 J 1192012 Corn001 Small Grain0042 S 1292012 Clover / Grass, M050 Clover / Grass, M0503 S 20 Bermuda Hay, E043 Bermuda Hay, M044 CROP CODESE = establishment (1st year)

7 M = maintenanceSG = small grainField Crops001 Corn, grain002 Corn, silage003 Cotton004 Small Grain 005 Millet, pearl006 Milo (Grain Sorghum)007 Peanut008 Rice009 Sorghum, syrup010 Soybean011 Sunfl ower012 Tobacco, burley013 Tobacco, fl ue-cured014 Tobacco, greenhouse015 SG silage/ Soybean016 SG silage/ Corn silage017 Kenaf, fi ber 018 SG/ Soybean (double crop)Home Lawn & Garden020 Azalea/ Camellia022 Lawn, centipede023 Flower garden024 Vegetable garden025 Mtn. Laurel/ Lawn (not centipede)028 Rose029 Shrubs 030 Berries/Fruit/Nuts031 Tree, shade032 Blueberries, homeChristmas Trees034 Leyland Cypress035 Line-out/ Seed beds036 Fir/N.

8 Spruce/Hem, E037 Fir/N. Spruce/Hem, M038 Pine, white or Bl. Spruce/Red CedarForage & Pasture040 Alfalfa, E041 Alfalfa, M042 Com. Bermuda/BahiaForage & Pasture (cont.)043 Bermuda hay/past., E044 Bermuda hay/past., M047 Bluegrass pasture048 Bluegrass/Wh. Clover049 Clover/Grass, E050 Clover/Grass, M051 Gamagrass053 Legumes, Fescue/OGrass/Tim, E055 Fescue/OGrass/Tim, M056 Prairiegrass057 Switchgrass059 Sudan/Sorghum Sudan/Sorghum silageRoadside Areas061 Critical area062 Grass, roadside, E063 Grass, roadside, MWildlife Areas / Food Plots 066 Deer/Turkey067 Upland Game068 Waterfowl069 Fish PondCommercial Hort Crops ONLY[024 = all Home Vegetables]

9 070 Asparagus, E071 Asparagus, M072 Beans/Peas073 Beans, pole074 Beet075 Blueberry, E076 Blueberry, M077 Brocc/ BSprout/Caulif079 Cabbage080 Cantaloupe/Melons084 Corn, sweet085 Cucumber088 Grape, E089 Grape, M090 Kale/ Mustard/ Spinach093 Okra095 Pea, southern096 Pepper/Sage097 Plant bed, vegetable098 Potato, Irish099 Sweetpotato100 Radish101 Canola/RapeCommercial Hort Crops (cont.)102 Black/Raspberry, E103 Black/Raspberry, M107 Squash/Pumpkin108 Strawberry, E109 Strawberry, M110 Tomato111 Tomato, greenhouse115 Turnip116 Vegetables, other118 Strawberry, plastic119 Hops175 Grape - vinifera Commercial Nursery & Flowers120 Dahlia121 Gladiolus122 Greenhouse123 Gypsophila (baby's breath)

10 124 Flower, bulbs125 Flower, roots126 Container nursery132 Rhod/Ginseng/Natives136 Tree nurseryOrchard, Fruit & Nut130 Apple, E131 Apple, M138 Peach, E139 Peach, M140 Pecan, E141 Pecan, MForest Trees & Seed133 Hardwood, E134 Hardwood, M137 Pine nursery142 Pine, E143 Pine, M144 Hardwood, seed145 Fir/Spruce, seed146 Pine, seedFine Turf150 Fairway/Athl. turf151 Tee152 GreensStormwater200 Bioretention cell$$