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-- ANALYTICAL REQUEST/SAMPLE CHAIN OF CUSTODY— LAB TRACKING # - �-Q-f <br /> RECORD OF � DATE ItECIEVED -- ------ <br /> B.INVOICE TO <br /> DEL-TECH GEOTECHNICAL SUPPORT SERVICES LAB. <br /> tai <br /> 10624 OLIVE AVENUE,OAKDALE,CA 95MI _Y:131.-_—Y�4'M. -- <br /> OFFICE-92097 847-8757 pHA }-.i �ONTACT _-I C <br /> FAX -(209)847-7744 �------ - -..-..— .. ---- ------ <br /> CALEFORNIA CONTRACTORS LICENSE#6573661 CLASS"A"ENGINEERING <br /> 11,1!llli!+�l1 ILII 1'111 I'�I 'f!li!I!1!i!illlii,l!E!!iEI'ip!i ff4k,E!!;€IE!E;p!,i!�i111!!'II'il ;j l;l II��!;;l;',i!I!I!�'E EIIlfllli 'i!,i!!!+!�'''I `I I ill'uII E{i[++Il;l LAB ANALYSIS R6QUFSiFD SITE SAMPLING MAP <br /> !I Il I ,IE{li EE l, I <br /> CLIENT AA CONSULTANT 8 \ Mom <br /> SPIE NAME 4A_A PROJECT AAA4 <br /> ADDRESS 3 FL CITY ST Ila <br /> ddSAMPLER SIGNATURE 1c. rq <br /> SHIPPED VIA WAYBILL# go <br /> c a <br /> $ F, <br /> ANALYSISBY TURNAROUNDTIME DAY w w m W W <br /> p11!!! SAMPLE I D If DATE TIME CONTAINERS TYPE MATRIX !!!!!i! I�!!!! !!!1!il 1!f!!+;! III.!I' ii!!+!!� ii!li!1 'U�!! "!I`I ♦111!11 REMARKS I IAB ID <br /> 1) t <br /> 2) — 11 96155 <br /> 3) vwl.20- ID fllo, 7� <br /> 4) <br /> s) 'L <br /> 6) t&�— �. <br /> 7 y "'� <br /> B) {I■Yuu b <br /> S) <br /> 10) r <br /> 11) "`� IS 7v <br /> 12)lcyv i.,r— Z <br /> 13) PC b-50 oxwp— <br /> I4, - 0 Z �- <br /> Is) d 1$ " <br /> REI a+W tsr�E�ay DATEOTRAE <br /> B��BY ftllgjOE=EgVATtVrfSl <br /> SAMPLE INTEGRITY/CONDITION <br /> r (MNAaURi7 RECEIVED COLD&INTACT r Yes NO <br /> DATE I <br /> REL NQ MIEDBI ♦ f,,,�,�S RECEWE•D ByAIIt BUB6LE51N V O A S r YES NO LIN 5 R <br /> r[�3 (SIGNATURE) 411 /� "r CUSTODY SEALS INTACT I YES 1 NO( NIADATE/lUft REUNgUI3HEDBy RECEIVFDPRESERVATIVES USED I YES NO <br /> r (S—A-RE) t/ <br /> NOTE PLEASE ARCHIVE THE SAMPLES SUBMITTED FOR THE FULL HOLDING TIME ALLOWED UNLESS OTHER ARRANGEMENTS ARE MADE * (MTBE„T.A M E,E T BX,D I P.E,T B.A) <br /> B B =BAILrR BI AN KS COLLECTED IN THF F7rLD F B =FIELD BLANKS COLLEC FED IN THE FIELD <br /> PINK FIELD COPA WHITE&I ELLIM TO LAB W ITIl 59MPLES 1 ELLOIN RETURN To(LIENT%ITII RESULTS DFI,TFCII C O( FORM 99 <br />