Form for submission of live plant material for rubber disease/pest identification
Name
: ____________________________________
Date: ___________________
Address : ____________________________________
Phone : ______________________
Cell
: ______________________
Email : ______________________
No of samples :
Clone :
Age of Plants :
Tapping stage/year :
Frequency of tapping :
Description of problem
Symptoms: Plant Part(s) Affected:
Distribution of Problem: Nature of Planting:
( ) entire plantation ( ) nursery ( ) random
Chemicals & Fertilizers:
( ) none applied ( ) rate and date applied below
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