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�1 <br /> -- ANALYTICAL REQUEST/SAMPLE CHAIN OF CUSTODY-- LAB TRACKING ._ ►:_ ��rz . <br /> RECORD OF DATE RECIEVED .._... _.._ <br /> TDtEL-TEcH GEOTECHNICAL SUPPORT SERVICES LAB INVOICE TOOLIVE AVENUE,OAKDALE,CA 95361 <br /> FICE-(209)847.8757 " <br /> FAX -(209)847-7744 PH# (4- --L-}- q-1 -.�ITACT _..........� ._.�.^.—._.__.�—_�_.�.�.._. <br /> CALB?ORNIA CONTRACTORS LICENSE#6573661 CLASS"A"ENGINEERING <br /> OB# --- ---INVOICE#---.-------_-------.---P O # — <br /> �rhi 3{t�r f�yiitli <br /> 17 <br /> ' h ' lIq Itrird 3r1 + ell ru cr rr4�i 11 'I' LAB ANALYSIS REQUESTED SITE SAMPLING IAP <br /> p <br /> CLIENT CONSULTANT 67- § 1,�� H 9_ Ital <br /> [Al <br /> TE NAME G PROJECT �, ! t.,rt VM] ����qq, �v7 <br /> DRESS _Lt � � CITY E ST C& <br /> MPLER SIGNATURE + . ! I g C C A <br /> TIPPED VIA U t G�� WAYBILL# �"�� � � � a g � � � � �•� <br /> � F <br /> ANALYSISBY TURNAROUND TIME DAY �: 0�1 sett m Gruel W <br /> SAMPLBI AO DATE 77ME CONTAINERS TYPE MATRIX :,III <br /> REMARKS/IAB I D <br /> 4-v 6pr <br /> 3) a X33 t <br /> 4) 'fit' 6 <br /> I toll <br /> 6) <br /> 9) - 1 5-7 1 <br /> 9) YAW-. 4 1 o <br /> 1 .6._ ¢1 <br /> ID) �' I <br /> I1} <br /> 13) �R.a <br /> 14) <br /> LS) <br /> RFL7Nft�LflS}BD Bt IRECM <br /> VM Bt 17/1 TRoffi <br /> SAMPLE INTEGRITY/CONDITION <br /> RECEIVED COLD&INTACT/ YES NO f 1 <br /> ABR BUBBLES IN V OA S /YES{ NO( "LINE{ # <br /> Ir f /�f (SKBVA fURBI 6FJ11�d/ i[rJ 1 !{�f� I CUSTODY SEALS WALT /YES Cgwr NO( NIA t 1 <br /> (J rDATUIlTa DA7EIT061fi <br /> RELINQULSREDRI RECEIVFDBI PRPSERVATrMSUSBD / YES If IAO l <br /> 1 (sul%[ATuw TYPE QE EEMER]7 Ll <br /> NOTE PLEASE ARCHIVE THE SAMPLES SUBMITTED FORTHE FULL HOLDING TIME ALLOWED UNLESS OTHER ARRANGEYIENTS ARE MADE (NLT B.E T.A.M.E„E T.BR„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 FIELD COPi WHITE&I ELLOlS TO LAB R ITH SAMPLES I ELLOW RETURN TO CLIENT WITH RESULTS DEL TECH C O C FORM 9SS <br /> ar <br /> :f <br />