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-- ANALYTICAL REQUEST/SAM, CHAIN OF CUSTODY-- LAB TRACKING # ----------------------- <br /> RECORD I 0F � ` �7' U I BATE RELIEVED ---=----- ------------- <br /> DEL-TECH GEOTECHNICAL SUPPORT SERVICES LAB INVOICE TO ------------- --- --.--..- <br /> 10624 OLIVE AVENUE,OAKDALE,CA 95361 ... ..:eft- 1x�...-� ... .. -- � ---- ��`-�_— <br /> 5.+ <br /> OFFICE-(209)847-8757 <br /> FAX -(209)847-7744 PH# ACT --- -------------- -- ----------------------- <br /> CALIFORNIA CONTRACTORS LICENSE#657366/CLASS"A"ENGINEERING � � <br /> JOB# INVOICE#......_.._.__......._ P O # --..._... <br /> I 11 4"' !' I I 113 3N 1 < lu 1 1 n[k' !E 111 °[t I 111'111111`Ellhll Illu'11i1 111'1 1 1 1111 I i f i ' 4 II 1 11111 I I II h1141111 'I I lu8 1 lu <br /> II I I ['u I ' i'Illall]lik r4 ;nllh a I I " 1!1111 I f n'.un U I j 1 j IL`11111 I`i1111ii'11 II 0I'' 1111111 h111 Ilu1 an 1111111111`II h1 II ' I+ 1!° <br /> LAIANALYSL4 REQUESTEQ(PLEASE PRINT) SITE SAMPLING MAP <br /> CLIENT } CONSULTANT <br /> SITENAMEIyAJIM BRb, PROJECT . <br /> D4V')_ E-s <br /> ADDRESS %14 �. � ., CITY- L ST , <br /> SAMPLER SIGNATURE o S <br /> SHIPPED VIA .. WAYBILL# <br /> ANALYSIS BY. TURNAROUND TIME DA'Y(S) <br /> SAMPLE I.D A DATE TIME CONTAINERS TYPE MATRIX Ijllli I['1111 6uipj 11'1111 11111111 IEII,iEl 1EI1E'1 111'!111 I'p11 I'll r <br /> ! .11 IoM 1 1111 tl,1111 REMARKS I LAB ID #S <br /> 1) �` 01; xx <br /> 3) f <br /> 4) <br /> 6) i <br /> 7) I <br /> 10) •, ,d Y3 1 a <br /> 18 uAroy on <br /> 12) <br /> 13) <br /> 14_) <br /> IS) 1 <br /> < ) DATEfTIME IMME <br /> REL1Nvu1slDSYit 9 R> Dar ,� / � SAMPLE INTEGRITY/CONDITION <br /> r <br /> SIGNATum RECEIVED COLD&INTACT / YES f NU <br /> y DA7E111ME Y ATE!Clhffi <br /> RELINQU1SBEDBY f ; ,r r _ftF! (/r.�� BY f r r� Q AIR BUBBLES IN V O A'S /YES NO LINWS)I <br /> 5311A i.T CUSTODY SEALS INTACT /YES ( ge NO f 1 N/A I 1 <br /> s DATElTIME DATE/TIME <br /> RIInIQIns11FDa� <br /> RECEIVED BT IVES USED ! YES ( NO f S <br /> r ISIGNATUREI I TYPPOPPRESERVAME(S) <br /> NOTE PLEASE ARCHIVE 7H13 SAMPLES SUBM11 TED FORTHE FULL HOLDING TIME ALLOWED UNLESS OTHER ARRANGEMENTS ARE MADE <br /> B B =BAII FR BLANKS COLLECTED IN THE FIELD F B =FIELD BLANKS COLLECTED IN THE FIELD <br /> wNrr vecl n rnaa a urTr a i cr r nu Tn r*o u 1Tu c•wor cc •FT r nw DCTI IDN Tn r'i 1FNT w ITN RFCT11 Tc nFl TFrH r tic FIIRK1 vii <br />