EXPERIMENT STATION. 21 



THE CONNECTICUT 



AGRICULTURAL EXPERIMENT STATION, 



New Haven, Conn. 



Form for Description of Sample. 



Station No. Rec'd at Station, 18 



Each sample of Fertilizer sent for gratuitous analysis must be 

 accompanied by one of these Forms, with the blanks below filled 

 out fully and legibly. 



The filled out Form, if wrapped up with the sample, will serve 

 as a label. 



Send with each sample a specimen of any printed circular, 

 pamphlet, analysis or statement that acompanies the fertilizer or 

 is used in its sale. 



Brand of Fertilizer, 



Name and address of Manufacturer, .. 



Name and address of Dealer from whose stock this sample is 

 taken, 



Date of taking this sample, 



Selling price per ton or hundred, bag or barrel, 



Selling weight claimed for each package weighed, ._. 



Actual weight of packages opened, 



Here write a copy of any analysis or guaranteed composition 

 that is fixed to the packages. 



Signature and P. O. address of person taking and sending the 

 sample. 



