40 BULLETIN 555, U. S. DEPARTMENT OF AGRICULTURE. 



(Name and location of laboratory:) 



Report on Sample of Semi-Gravel, Top Soil, or Sand Clay. 



Laboratory No. 

 Name 



(Date reported.) 



-, 191__ 



Identification marks 



Submitted by Title Address 



Sampled , 191__ Received , 191. 



Sampled from 



Quantity represented '. 



Source of material 



Location used or to be used 



Examined for 



TEST RESULTS. 



Analysis of material passing 10-mesh sieve. 



Sand retained, 20 mesh 



Passing 20, retained 60 mesh . . - 

 Passing 60, retained 100 mesh. . 

 Passing 100, retained 200 mesh. 



Percent. 



Per cent. 



Total sand . 



Silt 



Clay 



Total 



Total sand retained on 60 mesh . 



Per cent. 



Character. 



Coarse material, per cent. Quality, 



Mica, 



Remarks : 



Respectfully submitted, 



(Title). 



