Seed Mixture Report – Native Grass and Wetland Grass

				Date:
Project No.:				Seed Mix Type:
County:				# of Acres:
Contractor:				Lot #:
Species (Scientific name)	Origin	Lot #	Test Date	Purity (%)	Germination (%)	PLS %	PLS Factor
Species (Scientific name)	# PLS/Acre	# of Acre	Total # PLS	PLS Factor	Total Bulk Lbs.
				Total:
Lbs/Bag:		Acres/Bag:		# of Bags:

Seed Mixture Report – Urban and Rural

				Date:
Project No.:				Seed Mix Type:
County:				# of Acres:
Contractor:				Lot #:
Species (Scientific name)	Origin	Lot #	Test Date	Purity (%)	Germination (%)
Species (Scientific name)	Lbs. /Acre	# of Acre	Total Bulk Lbs.
		Total:
Lbs/Bag:		Acres/Bag:		# of Bags:

Certification Statement

The materials itemized in this shipment are certified to be in compliance with the applicable requirements of the Iowa Department of Transportation.
	Project No.
	County
	Seed Mixture Type
	# of Acres
	Total Bulk Lbs. of Mixture
	Lbs./Bag
	Acres/Bag
	Lot No.
	# of Bags
	Contractor
	Date
Company:
Name:
Signature:
Date:
List state(s) where company is an approved seed conditioner: