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-- ANALYTICAL REQUEST/SAMP CHAIN OF CUSTODY -- LAB TRACKING # � <br /> DATE RECIEVED --- / �� 1 <br /> RECORD OF A— - <br /> i <br /> LAB INVOICE TO ------ <br /> DEL-TECH GEOTECHNICAL SUPPORT SERVICES -off -- � ____ ..._____sem-'_I^ ,�------ <br /> 106,24 OLIVE AVENUE,OAINALE,CA 95361 ^Z- n <br /> !J 1 $ ls�.ICONTACT y ------ <br /> OFFICE <br /> -_ -------- <br /> OFFICE-(209)847-8757 <br /> PH# -- ...)---�____ -- <br /> FAX -(209)847-7744 ---- —P O#J' ,.d_! -�`v!1S.L--------- --- <br /> CALIFORNIA CONTRA LICENSE#657366!CLASS"A"ENGINEERING OB# -----_,.----__—.-INVOICE#- -- — <br /> I I' LAB ANALYSIS REQUESTED SITE SAMPLING MAP <br /> I I I II k �I�IIitIII I , III„ III,IIIIIIII III III II I I ul, n � �y_ 1 <br /> likll€lillllll;lj III i'I Ill;i,lknlii Ii I�!III;IlII,II Ilt i I II', It, .I t i I I ,�I�I „ i, , ,I �,,,,,I��fil 1, �i�n in,nll <br /> 4 <br /> CLIENT CONSULTANT (-Y-- ° y�+ t'II '*'Ib1 <br /> t•+ <br /> SATE NA PROJECT f <br /> owls, � <br /> ADDRESS <br /> SAMPLER SIGNATURE A C aQo opo + <br /> SHIPP�VIA AYBILL N 'p". <br /> TURNAROi]ND TTME DAY t� w m w w REMARKS I LAB I D <br /> ANALYSTS TTY TYPE 11" IIIIIIII II III II Ii i itll�k iiIIIII ilii)i !Iki�lll i G.. <br /> 111,1; SAMPLE r A DATE J TWECONTAINERS MATRIX <br /> III k{ I I <br /> 2) <br /> 4) - Sb <br /> T <br /> ki <br /> 6) _ b <br /> 10.) <br /> b t) <br /> tt) b <br /> I2) s �1114 <br /> 13) + <br /> 14) <br /> 15) ti A Ip6`t J SAMPLE INTEGRITY/CONDITION <br /> u >arnnst ��/ <br /> RF7.INWI�Ill / � �/ pf] kECE1VHD COLD&.INTACT ! YES ) NO { ) I <br /> �8y ,� 'rllR BUBBLES[N V OA'S ! YES NO�LIN 5 q <br /> Rp_aaQD1SF�n�y <br /> 14110 CUSTODY SEALS INTACT !YES NO( 1 NIA t 1 <br /> r � oZ/ 6D {slcs�tANRE} pA�r'In�rl: <br /> A / pRPSEktVATIVES USED ! YES NO I <br /> RF2ETVEP HY <br /> RA.A9QUtSEIt�9y ! 0 V <br /> ! (5[OM.47l1RE! <br /> (MT.BE,TAX E.ETB.E,DIPE,TBA) <br /> NOTE PLEASE ARCHIVE THE SAMPLES SUBMLITED FOR THE PULL HOLDING TIME ALLOWED UNLESS OTHER ARRANGEMENTS ARE MAGE <br /> =BAILER BLANKS COLLECTED IN THE FIELD F B =FIELD BLANKS COLLECTED IN THE FIELD Di:L TECH C O C FORM 98 <br /> B B <br /> WHETER 1 ELL014 TO LAB WITH SAMPLES y ELLON RETURN TOCLIENTWITH RESULTS <br /> PINK FIELD COPT ., <br /> �ar - <br />