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ANALYTICAL REQUEST/SAMPLE CHAIN OF CUSTODY-- LAIi.TRACKING #: •--• --------------- <br /> 1 <br /> 0 el <br /> RECORD OF !---` --- <br /> DATE RELIEVED: ---• -----•------------------ <br /> �� - .:� �' <br /> LAE.INVOICE T'O- --------------------------- ----•--='-----��`' -------------.------------------ <br /> DEL-TECH GEOTECHNICAL SUPPORT SERVICES , �� _� �� <br /> 10624 OLIVE AVENUE,OAKDALE,CA.95361 € ------------ "" --to A - <br /> OFFICE-(209)847-6757 <br /> FAX -(209)847-7744 PHI (��--)---- ONTACT: ----I ---.----_.__--------- <br /> - <br /> CALIFORNIA CONTRACTORS LICENSE#6573661 CLASS"A"ENGINEERING <br /> OB# ---------------------I OICE#----- --------------------P.O.# <br /> i ii-jl Iii il� :4 „i'', 1 11 illiii -L it I'� -:�,I LAD.ANALYSIS REQIIFST'ED <br /> , .;.:;',i ill;,!,,: !..,: .I ,,,i`; SITE SAMPLING MAP <br /> CLIENT. . [31 e" .� CONSULTANT. sstiaa� ,° <br /> SITE NAME: a. PROJECT- <br /> kil W1 I <br /> ,� p <br /> ADDRESS.13% CITY: r <br /> W <br />! SAMPLER SIGNATURE: <br /> SHIPPED VIA: WAYBILL#: <br /> ANALYSISBY: -i3 "i TURNAROUND TIME: DAYS �" F+ W w aNv W Will l <br /> !' <br /> „ - N.SAMPLEID.# DATE TIME TYPE MATRIX Ip,,I E '. <br /> REMARKS/LAB.I.D. <br /> z.) <br /> 092,41, <br /> c <br /> 3.) 1 <br /> i 6.) <br /> 7.) <br /> 9) <br /> I <br /> 1a.} <br /> 1 E.) <br /> lI 13 J <br /> 14.) <br /> DATE I TIME <br /> + ) RECEIVEDBY: f <br /> � <br /> SAMPLE INTEGRITY CONDITION <br /> RELQQiI5H3 <br /> - ;t (SIGNATURE) F�`r 'r ! f %l� RECB[VEDCOLD&INTACT 1 YES NO ( ) <br /> / DATElTN4E ,p <br /> RE.BVqu1SHW»Y: ;; ' r . t:.z r}+' ', E RECHIVED»Y. ,' - ,m�•'a/ AIR BUBBLES IN V.OA.'S I YES NO - LINE(S)4 <br /> ' f ` . `j i 1”' CUSTODY SEALS INTACT ! YES{ NO{ WA <br /> } <br /> FS.%• �� �.fs' (SIGNATURE) ��.! °,r <- <br /> ' T ll,7E! DATE ITIME <br />{ RELINQUISHEDBY: RECEIVED BYPRESGRVATIVESUSED 1 Y'ES NO <br /> NA ! (SIGNATURE] JILL p T -*karma <br /> NOTE: PLEASE ARCHIVE 711E SAMPLES SUBMIITED FOR TILE FULL HOLDING TIME.ALLOATD,UNLESS OTIIHR ARRANGEMENTS ARE MADE. (M.T.B.E.,T.A.M.E.,E.T.B.E.,D.1-P-E.,T.B.A.) <br /> 1 B.B.=BAILER BLANKS COLLECTED IN THE FIELD. F.B.=FIELD BLANKS COLLECTED IN THE FIELD. <br />+ PINK-FIELD['OPl' WHITE&YELLOW•TO LAE.WITH SAMPLES )'Ell-RETURN TCI CLIENT WITII RESULTS DEL-TECI1 C.O.C.FORNI 98 . <br />