Hemp Sampling Request To request sampling and testing, submit a complete copy of this form for each harvest lot or production areaAccredited laboratory of your choiceaccording to the laboratory’s procedures for requesting sampling. Grower Information GROWER NAME:BUSINESS NAME (IF APPLICABLE):Date:PHONE:EMAIL:LICENSE NUMBER:Hemp SamplingArea– Sampling will be performed in accordance with the Georgia Hemp Farming Act, O.C.G.A. 2-23-1, et seq., and GA. Comp. R. & Regs. 40-32 (https://rules.sos.ga.gov/gac/40-32).GROW SITE NAME:PRODUCTION AREA NAME:HARVEST LOT NAME:(Lot #)PHYSICAL ADDRESS:CityZIP / Postal CodeTOTAL SIZE OF PRODUCTION AREA: ACRESSQUARE FEETGPS COORDINATES: LATITUDE:LONGITUDE:(MUST BE IN DECIMAL FORMAT, EG: 45.123456, -123.45623) USPSDeliverySIZE OF AREA TO BE SAMPLED:ACRESSQUARE FEETAREA TYPE:INTENDED USE:STRAIN TYPE:DECLARED HARVEST DATE:Written Description: Describe the location of the production area or harvest lot such that the growing area is apparent from a visual inspection of the premises and is easily discernable from other production areas and harvest lots:STRAIN TYPE:Grower Request for Sampling and TestingApproved LaboratoriesAMERICANNA LABORTORIESCLEARWATER BIOTECHNEW BLOOM LABSSJ LABS & ANALYTICSSignature:Date:It is the grower’s responsibility to ensure timely sampling and testing . SUBMIT