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Get Tx D-1178 2009

use only. Sample #: Pmt type: Amt: fax: 979.845.6499 Accurate disease identification, diagnosis and management recommendations are dependent on submission of appropriate specimen with thorough background information. Incomplete information and/or poor sample may lead to inaccurate diagnosis. Refer to the back of this form for sampling and mailing instructions. PLANT DISEASE DIAGNOSIS FORM SUBMITTER CONTACT INFORMATION (PLEASE PRINT)  Photo _____________________ GROWER CONTACT INFORMATIO.

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