Seed Certification Service
031 Crop Science Bldg.
SEED POTATO FIELD INSPECTION APPLICATION
AND PRELIMINARY REPORT
Oregon State University
Corvallis, OR 97331-3003 (Use separate application for each seed lot) 2012
Lot Designation (YY-###) Variety Acres
Grower’s Name___________________ Address
Telephone _______________ Cell _______________ Fax_______________ eMail _______________
___________________________________________________ Township Range Section Quad
NOTE: Aerial photo must accompany this application showing field locations & access
(most recent first)
Date of Planting:____________________
Seed Source Information NOTE: verification of seed source, including a North American Health Certificate, must accompany applications)
Seed planted from _____________________________ ________ Winter Test Plot Approved? Yes ____ No ____
Grower’s name State
Lot ID:_________________ ____________ _______________ ____________
Lot number Certification Class Tag color (or grade) Bulk Tag No.
Do you plan to produce commercial potatoes? Yes ____ No ____ If “yes” – source of seed for commercial plantings: Own ___, Other* ___
Do you plan apply for Latent Virus testing? ______ Do you plan to Winter Test (required only for recertification)?: ___________
If “yes” and “other” “Seed Farm Requirement Form” and “Survey Of Uncertified Potato Fields” application must be completed.
I hereby voluntary apply for certification inspection and agree to abide by all the rules and regulations governing
certification in Oregon. I agree to sell as certified seed potatoes only those lots which have met all requirements of the
Oregon Certification Program. I understand that inaccurate information above may be cause to withhold certification.
Furthermore, I have permission from owner/agent to produce this variety if proprietary: ( ) yes, ( ) no, ( ) public variety-
not required (see Potato Certification Handbook Appendix A for information on variety status).
Applicant’s Signature Date
FEES Received. ________ acres x ________ $/acre = $ __________ paid Check No: __________ Date: ____________
INSPECTION REPORT (for inspector’s use only) NOTES:
Inspection: First Second Other
Leafroll tp/cs? tp/cs?
Mosaic tp/cs? tp/cs?
Inspector / Date R1__D1__R2__D2__ HI__ FR__
Classification: All field inspections complete____