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-- ANALYTICAL REQ UEST/SAMPLE CHAIN OF CUSTODY- LAB.TRACKING #: <br /> RECORD OF DATE RECIEVED: ----- --- <br /> LAB.INVOICE TO: <br /> DEL-TECH GEOTECHNICAL SUPPORT SERVICES <br /> 10624 OLIVE AVENUE,OAKDALE,CA.95361 <br /> OFFICE-(209)947-9757 `75 <br /> FAX -(20 )847-7744 <br /> CONTACT: <br /> CALIFORNIA CONTRACTORS LICENSE#6573661 CLASS"A"ENGINEERING <br /> OB# ---------INVOICE#---_-------_------------P:O.# <br /> fl 1i:,':111':�III;iIIIIIIIf,! 1 I, . III I III II iIIiII I lE IIIif lIII111f lI I E Illhli I III IIIIi II iifl�Ilil it�iil�lilllll i illi illi`illllII + I ANALYSIS REQLESI'lIIHill HhIIIII III SITE SAMPLING MAP ■ <br /> CLIENT: L CONSULTANT: G� �t I\ <br /> SITE NAME: PROJECT: D QTS t G, > i ,; itw <br /> ADDRESS: Ib i cTrY: rsz.4tTo sT-: a F o it <br /> t4b Ito 15 <br /> SAMPLER SIGNATURE: <br /> c1l <br /> SHIPPED L � a <br /> PED VIA: El> WAYBU #: e 2 a 1�- <br /> ANALYSISBY: TURNAROUNDT�: T �+�`iF- DAY(S) <br /> IIIIiII SAMPLE lil: DATE TIME ICONTAINMU TYPE MATRIX Iiiiiiii III ' I Il1II I 1 I'II IIII II II 1111111111111IN111111 1111101 REMARKS/LAB.LD. <br /> la b <br /> gym <br /> aN VAR _1 d. . <br /> za a <br /> 3-) <br /> 4.) `` <br /> 7.) LAR 31 <br /> 8) <br /> 9.) <br /> !la <br /> 13-) <br /> 14-) <br /> 15-) <br /> 5 RECEIVED BY: DATf.l TBS , <br /> Rr1.�+W ism B�•. SAMPLE INTHGFlTY/CONDITION <br /> (SKINATURE) r RECEIVED COLD&INTACT /YES NO ( ) <br /> A DATE l7'BHE <br /> REU NQUIIWED BY: RECEIVED BY: AIR BUBBLES IN V.O.A'S I YES NO LINE S N <br /> I (SIONA'(UM r CUSTODY SEALS I-,,ACT /YES.-**) NO( NIA ( <br /> A r/, Al'E l IF <br /> LRE-.D4QU9SNEDBY: RECEIVED BY: `• r L� f�Y. 91��D PRESERVATIVES USED ! YES NO f <br /> r (s1CNATURE) �llrr���-- �r r rS UTYPE OF PRESEL=E(Sj� <br /> NOTE: PLEASE ARCHIVE THE SAMPLES SUBMITTED FORTHE.FLIU.HOLDING TIME ALLOWED.UNLESS OTHER ARRANGEMENTS ARE MADE. (M-T.B.E.,T.A.M-E-,E-T.B.E-,D-1-P-E.,T.B.A.) <br /> B.B.=BAILER BLANKS COLI.ECTED IN THE FIELD, F.B.=FIELD BLANKS COLLECTED IN THE FIELD. <br /> PINK-FIELD COPT WHITE do YELLOW-TO LAB.WITH SAMPLES YELLOW-RETURN TO CLIENT WITH RESULTS DEI-TECH C.O.C.FORM 99 <br />