Form 69-006, Planting Report Instructions

Fill out with AI

This form contains 32 fields organized into 9 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
County Agricultural Commissioner
CountyNames ComboBox
Select, from the drop‑down menu, the California county in which the hemp planting is located and to whose Agricultural Commissioner you are submitting this report.
Madera Kings Orange San Diego El Dorado Merced Mariposa San Bernardino Sierra Yolo San Benito Napa Tehama Marin Riverside Contra Costa Colusa San Mateo Stanislaus Sutter Plumas Butte Glenn San Francisco Imperial Shasta Los Angeles Del Norte Humboldt Please Select Fresno Lassen Sonoma Mendocino Monterey Inyo Kern Lake Santa Cruz Siskiyou Alameda Ventura Solano Santa Clara San Joaquin Sacramento Modoc
Agricultural Commissioner’s Office Text
Type the street address (number, street, suite) of the County Agricultural Commissioner’s Office for the county selected above.
CountyCity Text
Enter the city (and if desired, the state abbreviation CA) that corresponds to the Commissioner’s Office street address entered in the previous line.
CountyNames ComboBox
Select the county for the second copy of the form (page 2) exactly as you did on page 1.
Madera Kings Orange San Diego El Dorado Merced Mariposa San Bernardino Sierra Yolo San Benito Napa Tehama Marin Riverside Contra Costa Colusa San Mateo Stanislaus Sutter Plumas Butte Glenn San Francisco Imperial Shasta Los Angeles Del Norte Humboldt Please Select Fresno Lassen Sonoma Mendocino Monterey Inyo Kern Lake Santa Cruz Siskiyou Alameda Ventura Solano Santa Clara San Joaquin Sacramento Modoc
Agricultural Commissioner’s Office Text
Enter the street address for the County Agricultural Commissioner’s Office on the second copy of the form.
CountyCity Text
Enter the city that matches the Commissioner’s Office address on the second copy of the form.
Form Text
Provide the main telephone number, including area code, for the County Agricultural Commissioner’s Office on the second copy of the form.
Cultivar Data
Cultivar name List
GPS coordinates
Global Positioning System (GPS) coordinates (from the approximate center of the growing area Number
Latitude (decimal degrees) taken from the approximate center of the growing area (e.g., 38.575764).
Longitude Number
Longitude (decimal degrees) taken from the approximate center of the growing area (e.g., ‑121.478851).
Planting location
Physical Address Text
Street address, road name, or nearest crossroads describing the physical location of the planting site.
City Text
City or unincorporated community where the planting site is located.
County Text
County in which the hemp is planted.
Zip Text
ZIP Code for the physical planting location.
General Description of Planting Location Text
Provide landmarks, field identifiers, or other notes that help describe where on the property the hemp is planted (e.g., ‘north‑east quadrant behind barn’).
Planting size
Total Planting Size Number
Numeric value representing the total area planted in this lot; enter only the number and then select the appropriate unit (Acres or Square Feet).
Acres CheckBox
Check if the total planting size entered is measured in acres.
Square Feet CheckBox
Check if the total planting size entered is measured in square feet.
Planting timeline
Planting Start Date Date
Calendar date planting of this hemp lot began. Use MM/DD/YYYY format.
Planting Completion Date Date
Calendar date planting of this hemp lot was completed. Use MM/DD/YYYY format.
Registrant contact
Primary Contact Name (Last, First MI): Same as Registrant Text
If someone other than the registrant should be contacted about this planting, enter that person’s name (Last, First, MI). Leave blank if you will check “Same as Registrant.”
undefined CheckBox
Check this box if the primary contact person is the same as the registrant named above.
Phone Number Text
Primary contact’s telephone number, including area code (e.g., 530‑555‑1234).
Email (optional) Text
Primary contact’s e‑mail address (optional but recommended for faster communication).
Registrant info
Registrant Name (Last, First MI or entity) Text
Enter the full legal name of the individual registrant (Last, First, Middle Initial) or the business/entity name exactly as it appears on your CDFA industrial‑hemp registration.
Registration Text
Enter your CDFA Industrial Hemp Registration Number as it appears on the certificate issued by the county agricultural commissioner.
Mailing Address Text
Enter the mailing street address (P.O. box or street/number) where the county can send correspondence regarding this registration.
City Text
City associated with the registrant’s mailing address.
State Text
State abbreviation for the registrant’s mailing address (e.g., CA).
Zip Text
ZIP Code for the registrant’s mailing address (5‑ or 9‑digit).
Signature & Date
Signature1 Signature
Sign here with the legal signature of the registrant or authorized representative attesting that the information on this Industrial Hemp Planting Report is true and correct.
Date Date
Provide the calendar date on which the above signature is executed (MM/DD/YYYY).