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Lab Request Sheet
Phone: (951) 795-3135 • Fax (951) 894-2683 •
Ship Samples To: 42184 Remington Ave, Temecula, CA 92590
Important: Please complete Project and Sample Identification Data as you would like it to appear in Report & include this form with samples
SoilCor Client No.:   Project Number:  
Company Name:   Project Name:  
Requested By:    
Phone No. & Ext.:   P.O. #:  
Fax Number:   Ship Date:  
email: Due Date:  
Results By:     Phone     Fax     email     Mail     Overnight Mail (charges apply)
Billing Address:

Sample # Boring # Testpit # Location Depth Tests Requested (Our Test No.'s)
Special Instructions: