Conservation and Survey Division
Donate/Drop Off Sample Examination Request

I have read and agree to the terms and conditions outlined in the Conservation and Survey Division's Sample Material Policies and Procedures

Contact Information
First Name
Last Name
Organization Name
Address 1
City
State
Zipcode
Phone Number
(xxx) xxx-xxxx
Email
Donate/Drop Off Request
Requested Drop Off Date
(dd/mm/yyyy)
 
Sample Information
Type of Sample  
Quantity
(approximate)
Hole/Well ID Number
Hole/Well/Project Name
Driller/Operator
County  
Section  
Township  Township Direction: N  
Range  
 
Interval Range
Are the Sample Dry?  

Contact

Michele Waszgis

Michele Waszgis

CSD Geological Sample Repository Curator

phone icon402-472-0693

mail iconmwaszgis@unl.edu