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LA <br /> -- ANALYTICAL REQUEST/SA MPLPHAIN OF CUSTODY -- LAB.TRACKING #: ----------- --••-- <br /> RECORD OF DATE RECIEVED: ------------- <br /> ------------- <br /> DEL-TECH GEOTECHNICAL SUPPORT SERVICES IAB.INVOICE TO: ___.___-__________ <br /> 10624 OLIVE AVENUE,OAKDALE,CA.95361 <br /> ONCE-(209)847-8757 ---------------- ----•----------- - ----------.. �___!_':._'....,,.. <br /> 9 � ------ <br /> FAX -(209)847-7744 PH (- ...- --} --- ---- CONTACT: ----- -•------------------------------------- <br /> CALIMRNIA CONTRACTORS LICENSE#657366/CLASS"A"ENGINEERING <br /> OB# ....----------------INVOICE*---- ---------------.----._................... <br /> LAB.ANALYSIS REQUESTER SITE SAMPLING MAP <br /> CLIENT: L CONSULTANT: <br /> 41L <br /> SITE NAME: PROJECT: ► 7-��� I * <br /> ADDRESS: ST.: 1 <br /> SAMPLER SIGNATURE: vDoti Ll Irr C o n owe <br /> SHIPPED VIA: - WAYBILL#: <br /> H <br /> ANALYSi5BY: j TURNAROUND TIME: DAYS .i . 2 a <br /> SAMPLE L1).0 DATE TIME CONTAINERS TYPE MATRIX REMARKS;I LLB.I.D. <br /> 1.) — C) '7 <br /> �? YYYVJ 9 a l 1 o a LI <br /> 3.) <br /> 4.) <br /> s.) <br /> e.) <br /> 7.) <br /> s.J <br /> 9.) <br /> I0.) <br /> 11.) <br /> 12.) <br /> 13.) <br /> 10.) <br /> 15.) <br /> ll QU1SHEDBY: q'- RECEIVED BY, ` �A SAMPLEINTEGRIMCONDITION <br /> (SIG (S)GNATURE) RECEIVED COLD&INTACT I YES f ) NO f ) <br /> _ DATE IMME <br /> RFISNQU1SHED B1': ( RECEIVED BY: C�- Zv-Q� AIR BUBBLES IN V,O.A.'S I YES NO LINE(S x <br /> (SIGNATURE) CUSTODY SEALS INTACT ) YES ) NO( I NtAblO <br /> f ) <br /> A DATE f TIME <br /> RE1NWISHE D BY: RECEIVED BY: PRESERVATIM USED I 1•E f NO <br /> 4 1 I (SIGNATUREI ! O V T .S: <br /> NOTE: PLEASE ARCHIVE.TILE SAMPLES SUBMITTED FOR THE FULL HOLDING TIMI;ALLO)AtiD,UNLFSS OTHER ARRANO&NEWTS ARE MADE. (NI.T.B.E..T.A.S9.E.,E.T.B.E.,D.I.P.E...T.R.A.) <br /> B-B.=BAIIJ R BLANKS COLI.E(-M.D IN THE FIELD. E.B.=HL-LD BLANKS COLLEC71.7)IN TIT- <br /> PINK <br /> ITPINK-FIELD COPY WHITE A SELLOW.TO LAB.WITH SAMPLES YELLOW-RETURN TO CLIENT WITH RESULTS DEI,TECII C.O.C.FORM 98 <br />