| Grower/Applicant Name |
Variety Name |
| Grower/Applicant Address |
| CSGA Grower No. |
Seq. No. |
Field no. |
Crop Code |
Acres |
| Dates of Inspections |
First |
Second |
Third |
Descriptions of Inspection Counts (Minimum of 6) and
Impurities
Minimum Total Plant Population Count Required - for Plots = 20,000 plants, for
all other classes = 10,000
Optimum Total Plant Population Counted - for Plots = 120,000, for all other
classes = 60,000. Use Additional Pages if Required
| Inspection Date |
No. of Counts X |
Plants/Count |
Total Plant Population Counted |
Description of Impurity e.g.
Dioecious or All-Male Plants |
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Record of Counts (Minimum of 6) of Impurities
| Inspection Date |
Impurity |
Counts |
| 1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
Sub Total Counts |
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Percentage (%) if Impurities and Additional Counts (if
Required)
% = Total Counts ÷ Total Plant Population Counted x 100
| Inspection Date |
Impurity |
Counts |
| 11 |
12 |
13 |
14 |
15 |
16 |
17 |
18 |
19 |
20 |
Total
Count
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% |
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| When was Grower/Applicant Advised of Impurities? Date
Time |
| Was crop rogued after Applicant was Advised of Impurities? Yes
No No information |
| Type of Industrial Hemp Monoecious Dioecious Hybrid |
| Comment
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| Inspector's Signature |
Date |
| Inspector Number |
Inspection Office Location |
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