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c !i V ` <br /> ... -- ANALYTICAL REQUEST/SAM ; CHAIN OF CUSTODY.-- LAB.TRA KING <br /> A. <br /> tu <br /> RECORD OF <br /> DATE RECIEVED: --- <br /> C <br /> .......... <br /> LAB.INVOICE TO: -- �_ ___ _ <br /> DEL-TECH GEOTECHNICAL SUPPORT SERVICES = - - ' ________________________________ <br /> 10624 OLIVE AVENUE,OAKDALE,CA.95361 - -- <br /> OFFICE-(209)847-8757 .__ --_— -------- <br /> FAX -{209}847-7744 PH.# {---------:-- ----------=- •CONTACT: ---- -g R <br /> CAFJFORNIA <br /> NG <br /> OB#! --------- ------- INVOICE# P.O.# ------------------ <br /> IJ,!! -- ----- <br /> O ACTORS LICENSE#6573661 CLASS"A"ENGINEERING <br /> €!pp1 3 r .•'Ir Ii'I €,,ilk€�,i,l;i€1!1. „1,I. it1111 »--•__-•_ <br /> ,pal f}il}ll II=,II•�'�I r ,3j�i3'I,,,rilrl €�ii €'I�„I,f u,. 111 �.rl�.�.;i€'. iii�ii gill€!lf' {ir IErlirf r Il, -'I,II r <br /> ii € r :;;n L";;,I.I-_�,I!€ €r �iiil.11llllli r.Ii' LAB.ANALYSIS REQD[SIED(PLEASEPR114Tj ,SITE SAMPLING MAP <br /> CLIENT-�` bf SDN CONSULTANT: T R(��y <br /> SITE NAME: PROJECT: I 1 > + I'L J_ $ <br /> ADDRESS: , CITY: E <br /> SAMPLER SIGNATURE: <br /> SHIPPED VIA: WAYBILL#: <br /> ANALYSIS BY: 'S' its TURNAROUNID TIME• DAY(S) r y C <br /> SAMPLE L D.# DATE TIME CONTAINERS TYPE MATRIX <br /> I,I„r l I€€,,,€..flrll,l €€ lrrE rll L 3!!II r Illi ;Jiil3 li REMARKS B.LD.#'S <br /> z.) XAq5 C3 <br /> f 3.' 1 ► 15 <br /> 4.y <br /> 6.) V'F�W . <br /> 7.) <br /> 9.1 <br /> ]z.y <br /> i . <br /> 14.) 4 <br /> D 7E f 73A� -. <br /> miNQUISHMBY: x RECENEDBY: f e+ .i DATE1TFhEE <br /> 17 / ' SAMPLE INTEGRITY/CONDITION <br /> QIQ (SIGNATURE) <br /> `. I I DAtF r nME RECEIVED COLD&INTACT I YES ( ) NO( ) <br /> 1tEI.INQUISIFDBY: * 1' ,1 `�,—co RECflVEi <br /> , r N � DA7Elnn�f,8 a AIR BUBBLESINV.O.A.'S /YES f NO <br /> S GNA I (SIGNAT4 S <br /> CUSTODY SEALS INTACT /YES ( ) Np'f 1 MIA ( j. <br /> DATE/TI <br /> RELINQ[RSHEDBY: I i RF.["F1VEDA7EI.11ME <br /> PRESERVATIVES USED I YES ( NO(SIGNAT - <br /> 1 TYPE OP ESERVAT 3: <br /> MOTE:PLEASE ARCHIVE THE SAM PI SUBMITTED FOR THE PULL HOLDING TIME ALLOWED,UNLESS OTHER ARRANGEMENTS ARE MADE. <br /> H.B.=BAIL:ER BLANKS COLLECTED IN THE FIELD. F.B.=FIELD BLANKS COLLECTED IN THE FIELD. <br /> PINK•F1ELDCOPY WHITE&YELLOW-TOLAB.WITH SAAIPLES YELLOW-RETIIRN TO CLIENT W(TH RESULTS <br /> DEL—TECH C.I1C.FOR h1 98 <br />