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-t- <br /> 7 <br /> '' -- ANALYTICAL REQUEST/SAMPLE CHAIN OF CUSTODY— LAB TRACKING # _ _ <br /> RECORD OF DATE RECIEVED <br /> DEL-TECH GEOTECHNICAL SUPPORT SERVICES LAB INVOICETO <br /> 10624 OLIVE AVENUE,OAKDALE,CA 95MI ------------------------------------------------------ <br /> OFFICE-(209)847-8757 <br /> FAX -(209)847-7744 PH# (-�---)------------------CONTACT <br /> CALIFORNIA CONTRACTORS LICENSE#6573661 CLASS"A"ENGINEERING <br /> OB# ......-_....._-....INVOICE#- ....----- ------P O # -..._....._. --- <br /> ,� ,,3,' LAB ANALYSIS REQUESTED SITE SAMPLING MAP <br /> CLIENT CONSULTANT CM_Tl L L 15' WEIn1 f(� m * a '0VIA <br /> SITE NAME E PROJECT WM+L 0-4} <br /> ADDRESS X31 ► 1 S . CITY �(s[+ILTD sT �& .4 <br /> SAMPLER SIGNATURE 0 CD <br /> o d m <br /> SHIPPED VIA WAYBILL# Wx It ] <br /> ANALYSIS BY TURNAROUND TIME 10 DAY Er W aNa W <br /> SAMPLE LD 0 DATE TIME CONTAINERS TYPE MATRIX l i II <br /> I,� REMARKS/LAB ID <br /> 11 D � 11 l YIIX <br /> '15 ��ti IS c"T I . <br /> 1 rww- { $ 8 <br /> g <br /> 6 <br /> 103 S <br /> 3) 3 D Z3 <br /> ., <br /> 3. <br /> l � io <br /> '7TKIF Q ogn <br /> RFIWQUCg�BY RLiCEIVM BZDA"M r 7ASE <br /> SAMPLE INTEGRITY/CONDITION <br /> Is bey I LSX3NA7URL:l �t So� RECEIVED COLD&INTACT I Y NO f <br /> 91k 4 <br /> RF1.BiQU1S7fFD BY (p is elf, Bt AIR BUBBLES IN V OA 5 !YES NO LINEIS n <br /> (SKINAIUM (A 40 (SKINATIME) / CUSTODY SEALS INTACT !YES{ NO f ) N/A <br /> A DATEl7iMfi <br /> ui1I,,QU1SfIHDBY RECEIVED B) PRESERVATIVES USED / Y£5 NO <br /> RMATURn r (S)ONA7UREi r v <br /> OTE PLEASE ARCHIVE THE SAMPLES SUBMITTED FOR THE PULL HOLDING TIME ALLOWED UNLESS OTHER ARRANGEMENTS ARE MADE (M T.B E,TA M E..,E T.B.E,D I.P.E.,T.B.A) <br /> B =BAM.ER BLANKS COLLECTED E_C TED IN THE FIELD F B =FIELD BLANKS COLLECTED IN THE FIELD <br /> PINK FIELD COPS WHITE&i ELLOW TO LAB WITH SAMPLES 1 ELLOM RETURN TO CLIENT WITH RESULTS DEL TEC7i C 0 C FORM 99 <br />