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ANALYTICAL REQUEST/SAMPLE CHAIN OF CUSTODY— LAB TRACKING # ------------ ------------- <br /> L& RECORD OF I BATERECIEVED --- - j=-�-- - - <br /> LAB INVOICE TO �.....---- rf-- - t..._ -�.;� � <br /> DEL CH GEOTECHNICAL SUPPORT SERVICES � r� � ; ¢ r 1` T <br /> 10624 OLIVE AVENUE,OAKDALE,CA 95361 - - 3,....---- =---- <br /> OFFICE-(209)847-8757 { } r <br /> ( I is ONTACT <br /> FAX -(209)847-7744 PH# (...,.:__...�:- --------- ------------------------------_.....__ I <br /> CALIFORNIA CONTRACTORS LICENSE#6573661 CLASS"A"ENGINEERING <br /> l ,� OB# -----�.....----..INVOICE - - ----P O <br /> ', # ---........__—w.... <br /> ' u, !" LAB ANALYSIS REQUESTED ^SITE SAMPLING MAP~ <br /> CLIENTC-misenr,aP A i 3 } CONSE3LTANT f <br /> SITE NAME I - ,Crll PROJECT111, 40RNZIPMaq, <br /> �n <br /> ADDRESS 11# ) v�"`Q dlk hP - cm {� �-� ST �- � � F <br /> SAMPLER SIGNATURE 'S ,( rill, '� <br /> SHIPPED VLA} r I \ WAYBILL# m 00 <br /> ANALYSISB '�( 1 TURNAROUND TIME vv � DAYS + w w o W w <br /> ii !'i SAMPLE LD P DATE TIME CONTAINERS TYPE MATRIX i+q ,i i! 3!" +;rl 'I, " ''! +! ! " o' REMARKS I LAB I D <br /> „!i <br /> 1) f4 _ # — � <br /> x) �! ' Ve 1 <br /> 4) i�l �d <br /> 6) al ' � ' ST <br /> 7) 1 <br /> 10) <br /> 11,1111 U)- <br /> 12) <br /> 13) li"1 � i 1 -ii � <br /> 14) 11L <br /> 15) Dr <br /> oARr,[ [ven By s' j � SAMPLE INTEGRITY/CONDITION <br /> RELINQUISHEDBt <br /> (SK3NATllRE} ` ' F' I RECEIVED COLD&INTACT I M NO ( ) <br /> / - r v ❑ATEITLNS <br /> RF7.¢3QU[SIiFD B1 RrOMWED 61 t ;r-, if AIR BUBBLES IN V OA S !YES 7 NO 1� LINES # <br /> I 1 <br /> (SICINA'3LRE) { L .��-. # M (7fy(1) CUSTODY SEALS INTACT !lE5 f.03 NO f 1 NIA f 3 <br /> d M E/TIME <br /> REI..RrQU[SFffDBY RECEWDB5 PRESERVATIVES USED ! tiFS NO <br /> ! <br /> (SIGNATURE) TYPE OF PRESARWIYNS) <br /> NOTE PLEASE ARCHIVE THE SAMPLES SUBMITTED FOR THE PULL HOLDING TIME ALLOWED UNLESS OTHER ARRANGEMENTS ARE MADE � (M T.B E TAME E T B E,D I.P.E,T B.A) <br /> B 8 =BAILER BLANKS COLLECTED IN THE FIELD F B =FIELD BLANKS COLLECTED IN THE FIELD - - <br />