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-- ANALYTICAL REQUEST I SAMPLE CHAIN OF CUSTODY -- LAB.TPACKINC It:
<br /> RECORD OF DATE RECIEVED:
<br /> DEL—TECH GEOTECHNICAL SUPPORT SERVICES LAB.INVOICE TO. -- -1 L''` ----Y ----------------------------------
<br /> 1467.4 OLIVE AVENUE,OAKDALE,CA.45361 - �- C4 A
<br /> OFFICE-(109)$47-6757
<br /> ------------------
<br /> FAX -(104)847.7744 PH•I1 ( --) � CONTACT.•
<br /> CALIFORNIA 00WRACfORS LICENSE M 6573661 CLASS"A"ENGINEERING
<br /> OR 4 ------ NVOI(L 9 -
<br /> II II 111111 I III'I I li I 7_71,117,17,17,77 ;IMI i,'. I I ;I I li,i( ilfl IIi,E'N,i f I!I III!l;:,to l'Illi�l I,I'il!.'Ef'� LAB.ANALYSIS
<br /> Ilillila,,6u,ll,ll„I:I,LII,f I,I,•I,I IIIA,. ,I,I,.II IIIL,;,,,3,i::,:;.;,,::,111,.1 if I,;I,,,;,:I I.I,• I. SITE SAMPLING MAP
<br /> CLIENT: CONSULTANT: c - a
<br /> STT$NAME: Sri 1 E PROTECT: +
<br /> ADDRESS: E- <mCITY: ST,
<br /> SAMPLER SIGNATURE: 0 Ll _
<br /> SHIPPED VIA: WAYBILL t: f-
<br /> ANALYSIS BY: TURNAROUND TIME: DAY—
<br /> (S) pau So W W
<br /> 1;1r1i1 SAMPLE LLk R DATE TIME CONTAINERS TYPE MATRIX liill i' ''! I I! 1111111 IIIIIIII lull I!I lill! Illilll Iliiilll 'i III' VIII REMARKS I IAB.I D.
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<br /> Rrr n+vwsan BY: �"i "TU a` DATEr7VAE
<br /> „•%6 � r 7/' /7,? SAMPLE INTEGRITY I CONDITION
<br /> (SPOHATl1RE) r RECEIVED COLD A INTACT I YES NO( )
<br /> [A'[E 1 Tart$
<br /> RII.INQUISFff•D B5': /� �f J/r� Q RECEIVED BY: L jY J � �.'�/�L•/C?j AIR BUBBLES IN V.O.A'S /YES( NO LIN S M-
<br /> IMNATURE) !/ 1, �i [s)orun)rsEf f! ./ /�.1. - ( r `-`-l(`.1� �JBr� T i CUSTODY SEALS INTACT 1 YES ( } NO( ) NfA f
<br /> MINQUISI-MBY: RECEIVED BY: PATErTIME PRFSERVATFVES USED 1 YES NO f
<br /> ! (SUNATURE) r O V
<br /> NOTE: PLEASE ARCHIVE ME SAMPLES SUBMITTED FOR THE PULL HOLDING TIME ALJ OWfiP.UNLESS OTHER ARRANGPMENTS ARI;MA[>1;, � (M17.T.R.E.,T.A.M14.E 17-1'.B.li.,D.1.1'.I:..T.B"A.)
<br /> B.B.=BAILER BLANKS COLI,EC ED IN THE Ill l.[]. F.Q.=FTEIJ)BLANKS COLLECT[)IN T1IF FIELD,
<br /> Pi NK-RFLP('OPY u'HFTE&YFLLOW,TO F IFS.A'ITII S.ANWLES VELLOSY-Fz TL!RN TOCLIFNT%%'ITff RUSUI.TS [)E1:TFUli CO.C.FORM 99
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