<p> NEW YORK STATE DEPARTMENT OF TRANSPORTATION GEOTECHNICAL ENGINEERING BUREAU</p><p>DISTURBED (JAR) SOIL SAMPLE REQUEST</p><p>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: </p><p>SAMPLES REQUESTED M.O. DESIGNER OR REGION : Complete this Section, SAVE, email to Region and SML </p><p>Boring no. Samples Notes J- J- J- J- J- J- J- J- </p><p>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: </p><p>SML : Complete this Section, SAVE, email to M.O. Designer DATE RECEIVED IN SML: </p>