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.w �■■ ,� <br /> --Amlk <br /> ANALYTICAL REQUEST/SAMPLE CHAIN OF CUSTODY— LAB TRACKING ----------.-----.------- <br /> RECORD OF DATE RECEEvED <br /> -ma <br /> DEL-TECH GEOTECHNICAL SUPPORT SERVICES LAB INVOICE To —�' !Y-�- -- - ------------ <br /> 10624 OLIVE AVENUE,OAKDALE,CA 95MI .�� , m�ST°.- <br /> OPMCE-(209)847.8757 <br /> FAX -(209)847-7744 PH 4 (_o_- -)_abv�l"CONTACT ----fi-1- --..�..... ----- <br /> CALIFORNIA CONTRACTORS LICENSE 0 6573661 CLASS"A"ENGINEERING <br /> OB 0 ­-INVOICEf P O <br /> II{I}II'i E`I`IIII'NII E l,�uilliil�lfi,ll I kE I�}f [{,II�l,I IFli,lull}4}lilllllllllllllll1°I'„��I 1 j II}E[I!I I { III ll IE I�pil�li�illl I�i�l�� 'i�lllll hii l�llll�ll�lilidllili;I i' I�II I l I;i l III I f f'lull {All, LAB.ANALYSIS REQUESTIDlillE, i <br /> SITE SAMPLING MAP <br /> CLIENT CONSULTANT19�Fold ` <br /> SITE NAME PROIE.CT a I N <br /> o <br /> ADDRESS CITY ST O I i <br /> SAMPLER SIGNATURE <br /> chi $ H <br /> SAIpPF.D VIA WAYBII.L p $ <br /> ANALYSIS BY TURNAROUND TIME DAY( F W a�cl �o W4L 4 <br /> "i'; SAMPLE I.D! DATE TIME CONTAINERS TYPE M *RIX li II IIII illllil �Eill�ll lIIEIIII III I Ili�ll� II II 1IIE'li i ,jlj � REMARKS/LAB I D <br /> L) D <br /> L) 3 <br /> 3) wCk 1-1 <br /> 4) r <br /> 5) .� <br /> 6) b <br /> 7) <br /> 10) <br /> II) <br /> 11) <br /> 13) <br /> 14) <br /> 15) <br /> TW <br /> RII.aroUISHM t ' 4 6 RMEIVEDBY 1� � SAMPLE INTEGRITY/CONDITION <br /> 1� (SIONAtURE7 `� �/ p RECEiVEDCOLDAiNTACT ins NO <br /> RElUNQUt%WBt ,t/ / S RB�IVFDBY n� rTu <br /> AIR BUBBLES IN V O A S 1 YES NO LI S q <br /> fs tS1AE1 CUSTODY SEALS INTACT / YES NQ f NIA <br /> v _ D ly�E <br /> [:nBuQu[51�vBt RF 3VFD8t / PRESERVATIYESUSED 1 YES NO <br /> TYPE OF PRIESUV&=,jj <br /> NUM PLEASE ARCHIVE THE SAMPLES SUBMITTED FOR THE FULL.HOLDING TIME ALLOWED UNLESS OTHER ARRANGEMENTS ARE MADE * (M TM.E,TA M E,E T.B E,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 COPS WHITE&S ELLO%% TO LAB R ITH SAMPLES S ELLOW RETURN TO CLIENT R ITII RESULTS DMITECH C or e^” <br />