INSECT IDENTIFICATION SUBMISSION FORM
Office Use:
Date received
Insect Identification/IAEP
HAREC
2121 S First Street
Hermiston, OR 97838
Phone: (541) 567-8321
Fax: (541) 567-2240
Sample# EDDDI#
**** A fee of $32 may be charged to commercial entities **** NEW !!!!!
**** Please Note: The Clinic reserves the right to retain specimens submitted****
Client Classification Commercial Grower
Contact Name:
Phone:
Email:
Bill To Name:
Address:
Agent Name:
Silvia I. Rondon___________________________
Title:
Extension Entomologist and Specialist_________________
Address: Hermiston Ag. Research & Extension Center______________
2121 S. First St, Hermiston, OR 97838________________
Phone: 541-567-6337
Fax: 541-567-2240 _________
Email: [email protected]______________________
Website: http://oregonstate.edu/dept/hermiston/silvia-rondon
Phone:
Email:
Date collected
Reply to: Contact
OSU Extension ________________________
Home Owner
Collection location
Bill To
Agent
Crop/Garden
yard/landscape
lawn
vegetable garden
other
via E-mail
Phone
field crop
greenhouse
orchard
Mail
Fax
golf course/sod farm
Christmas/tree plantation
nursery (
container
field)
Additional Information: Host plant + variety
Part of plant affected
Field size/plant numbers
Field rotated from
Other comments
Medical/Veterinary
Host/patient
Association with other animals (specify)
Known geographic location of first contact
Patient Identifier
Pattern of damage
Age
Location on host
Home
Where in home
affected ( if in wood, be as specific as possible)
holes, frass etc.)
Other:
Symptoms
Recent travel or
Type of product
Kind of damage (include shape and size of exit
Pets:
_____________
Diagnosis and Information
Determination (Order: Family, Genus species)
Common name (if any)
Comments:
Extension Specialist
date
Acc. #