Sampling Request Form
FRM.SR.100
INSTRUCTIONS
AUCC or AUCP businesses must complete all sections below. Form must be received by Sampling/Transport Firm prior to dispatch.
Cannabis Sampling Solutions NY: OCM-CSF-00001
Section 1: Client Information
OCM Permit #:
Licensee Name:
Business Name:
Licensee Phone Number:
Please enter a valid phone number.
Date Created:
-
Month
-
Day
Year
Date
Client Lab Order Number:
Email Address
example@example.com
Enter Destination Of Sampling Site
Destination Details
Number and Street
City
State
Zip Code
County
Estimated Time Arrival Of Sampling Technician
Hour Minutes
AM
PM
AM/PM Option
Section 2: Laboratory Destination and Sample Information
Laboratory Selected For Analysis
Phyto-Farma Labs OCM-CPL-00004
If A Lab Other Than Phyto-Farma Labs Is Utilized, Please Provide Detailed Information Below.
Upload Work Order
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of
List Products Being Sampled and Transported:
Product Description
(Flower, Oil, etc.)
Batch ID Number
Lot Size
Package Size/Weight
Notes
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Cell 1
Cell 2
Cell 3
Cell 4
Cell 5
Cell 6
Cell 7
Cell 8
Cell 9
Cell 10
Cell 11
Cell 12
Cell 13
Cell 14
Cell 15
Cell 16
Cell 17
Cell 18
Cell 19
Cell 20
Section 3: Schedule Sampling Event
Priority
Check Required Time
NOTES
Standard
(48 Hours)
Rush
(24 Hours)
Emergency - Same Day
*Contact Sampling Firm For Confirmation
Requested Sampling Date and Time:
Acknowledgement and Signature
Authorization To Sample
Sign Below
Submit
Submit
Should be Empty: