Grower Residue Test Request

Sample to be collected by Rudge on (date)*

Sample to be collected from*

SAMPLE 1

SAMPLE 2

Grower Name*

Grower Name

Address

Address

Fax number

Fax number

Email*

Email

Product Type

Product Type

Variety

Variety

Check tests required
 C3 C4 C5 C6 CAD M1 M2 M3 M4 W1

Check tests required
 C3 C4 C5 C6 CAD M1 M2 M3 M4 W1

Ref Nos

Ref Nos

Comments

Comments

Please verify the code below
captcha