State of New York Department of Transportation
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NEW YORK STATE DEPARTMENT OF TRANSPORTATION GEOTECHNICAL ENGINEERING BUREAU
DISTURBED (JAR) SOIL SAMPLE REQUEST
ORIGINATOR: MAIN OFFICE REGION PROJECT INFORMATION M.O. DESIGNER OR REGION : Complete this Section, SAVE AS “Sample Request PIN xxx-xxxx MM-DD-YYYY”, email to Region and SML ([email protected], [email protected]) PROJECT: P.I.N.: CONTRACT NO: REGION: COUNTY: REQUESTED BY: GEB SECTION: DATE REQUEST EMAILED TO REGION: INSTRUCTIONS FOR SML STAFF:
SAMPLES REQUESTED M.O. DESIGNER OR REGION : Complete this Section, SAVE, email to Region and SML
Boring no. Samples Notes J- J- J- J- J- J- J- J-
REGION : Complete this Section, SAVE, email to M.O. Designer and SML NUMBER OF SAMPLE BOXES: SAMPLES SENT TO GEB BY: REGION: DATE SAMPLES SENT TO GEB: REMARKS:
SML : Complete this Section, SAVE, email to M.O. Designer DATE RECEIVED IN SML: