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-- <br /> ANALYTICAL-REQUEST/SAMPLE CHAIN OF CUSTODY- LAB.TRACKING #: <br /> RECORD OF DATE RECIEVED: --- `fr . 0 <br /> a --- ' -- <br /> LAB.INVOICE TO: ------- � . -.._ -------- <br /> ---------- <br /> ---- ----_--;----- <br /> FEL-TECH GEOTECHNICAL SUPPORT SERVICES <br /> FFI OLIVE�AVENU$,QAKDALE,CA.95361. .._.. "I............................. <br /> --- � F -------- -----------FAX <br /> -( - 2 847-8757 <br /> I FAX -(204)847-7744 PH-# ( ) CONTACT. .. <br /> CALIFORNIA CONTRACTORS LICENSE#657366!CLASS"A"ENGINEERING I <br /> QB# I BICE#........... ......._ <br /> ---------_.__. _ -----P.O.# ----......._—.._--------------__-- <br /> I <br /> I�4 I,'r!€lrf P,E{C.r il.I „ I niE,.: � ,. ° ° II i,i, ISI..• ;�''. 1 ,,.:f.;f , '. .. I• I. I Lllfi IliliI _ALA _NALY3_13— EQUESTED <br /> STrE SAMPLING MAP <br /> CLIENT: bw— <br /> CONSULTANT: 6T I <br /> SI E NAME: PROTECT: a lvnV ' <br /> >; w <br /> ADDRESS: CITY: v ST.: <br /> SAMPLER SIGNATURE: <br /> m F: <br /> SAIPPED VIA: WAYBILL#: m w <br /> ANALYSISBY: TURNAROUND TIME: r � , DAY(Rw w w w <br /> r3) <br /> SAMPLE LD.# DATE TIME CONTAINERS UPE MATRI%�q.. y . <br /> 5.) . y <br /> 3l.) <br /> l3.) <br /> 6 <br /> NATE <br /> ERECErVII <br /> RMINQUISl�BY, pD (SIONATURE) <br /> FCEiVEDBY: ° '� ' SAMPLE INTEGRITY/CONDITION <br /> 4r7 t COLD&INTACT 1 YES f1 No i ) <br /> RFLWQU[sl®EY: .�F t EE[ R+FABY: f AIR I3UBBLBSrINV.O.A.'S 1 YE5 NO LINOS B• <br /> II �y f 1 <br /> ¢'Y �!�� �-'•� - fCUSTODY SEALS INTACT' !YES m } NO( y NIA_ DATEITA(ERELNQIIISHED BY: ECE1VFDBY: PRESERVATIVESUSED ! YES SIGNATURE V <br /> NOTE: PLEASE ARCHIVETHE SAMPLES SUBMITTED FOR THE FULL HOLDING TIME ALLOWED,UNLESS OTHER ARRANGEMENTS ARE MADE. (M.T.B-E.,TA.WL,E-T.B.E.,D.I.P.E.,T.B.A.) <br /> B.B.=BAILER BLANKS COLLECTED IN THE FIELD. F.B.=FIELD BLANKS COLLEC.=IN THE QLD. <br /> PINK-FIF.1,DCOPA' WHITF,&VELLOW-TO FAR_WITHSAMPf.FC {-FLLOW-RPTURNT! rlJF,NTWTTHRFVTL-" I1R[,w..rHf.O.C.FORM 9R <br />