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-- ANALYTICAL REQUEST/SAMP CHAIN OF CUSTODY-- LAB.TRACKING #: __.....__�.. :... <br /> RECORD OF DATE RECIEVED: ------------------------------- <br /> DEL-TECH GEOTECHNICAL SUPPORT SERVICES LAY INVOICE TO: ------ <br /> 30624 OLIVE AVENUE,OAKDAI;E,CA.95361 ------• ----- --------- ------ ------------ ---- <br /> OFFICE-(209)647-8757 1 FAX -(209)647-7744 PH.#1lal�CONTACT: -zAi--- 1 ---- ------------------------- <br /> CALIFORNIA CONTRACTORS LICENSE#6573661 CLASS"A"ENGINEERING <br /> O # --------------------INVOICE#-------------------------P.O.# -------------------------•----------_.. <br /> 1 <br /> LAB.ANALYSIS REQUESTED SITE SAMPLING MAP <br /> JI. E . <br /> CLIENTCONSULTANT: <br /> F * <br /> SITE NAME: I!MLROJECT: 10. ) &I'Va X�Y1A�Z <br /> ADDRESS: Y: ST.: H O <br /> SAMPLER SIGNATURE: <br /> SHIPPED VIA: = WAYBILL <br /> ANALYSIS BY: 0 A TURNAROUND TIME: DAYS W w ao W W i'vw 1 <br /> SAMPLE I.D.I DATE TIME CONTAINERS TYPE MATRIK ! REMARKS/LAR.I.D. <br /> I.) - '\ <br /> 2.) t Yl`� 5 G 3,g 3 c- <br /> 3.) _y 3� <br /> 4.) -Mg <br /> 1r YY13G�a j <br /> 5.} �n� 01� v �- 3o� 3 <br /> a.) <br /> 9.) <br /> 16.} <br /> 1 E.) <br /> 12-} <br /> 13.) <br /> 14.) <br /> 15.) <br /> ` A RECEIVED BY: - 3 iS� SAMPLE INTEGRITY/CONDITION <br /> kRELEJBdQUlSF1F•D BY: �1 <br /> ! 1 (SIGNATURE) RECEIVED COLD&INTACT ! YES ( NO ! ) <br /> A DATE 19'A{E <br /> RECETVED BY � AIR HU9HL.ES[N V.O.A.'S ! YES NO f LINES M- <br /> (SIONATURE1 0�X �� Y CUSTODY SEALS INTACT /YES{ 1 NO( ) N!ADATE I T IME <br /> INQU.",EDBY: RE.[ENEDBY: PRESERVATIVES USED I YES NO ( <br /> ! 4SIGNATURE) ! o S: <br /> NOTE: PLEASE ARCHIVE TIIE SAMPLES SUBMTITED FOR THE FALL HOLDING TIME ALLOWED,UNLESS OTHER ARRANGEMENTS ARE MADE. � (M.T.B.F..T.A.M.E..F..T.B.E..D.I.P.E..T.B.A.) <br /> B-B.=BAILER BLANKS COLLECTED IN THE FIELD. F.B.=FIELD BLANKS COLLECTED IN THE FIELD. <br /> PINK-FiF.LD COPY WHITEA-YELLOW-TO LAB.WITH SAMPLES YELLOW-RLTURNTOCLIENTWiTH RESULTS D}I:TF.('H C.O.C.FOR AI 99 <br />