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-- ANALYTICAL REQUEST/SAMPLE CHAIN OF CUSTODY-- LAB TRACKING # -------- ------.- <br /> RECORD OF - DATE RECIEVED - --- ---- --�---- <br /> DEL—TECH GEOTECHNICAL SUPPORT SERVICES LAB INVOICE TOQ—�( U Tt���L L -- ,,,,¢— �JF ��f -- <br /> 10624 OLIVE AVENUE,OAKDALE,CA 95361 ---1. 7 _....91`_::_4f__1 lel . 1 r}.._ 1 ------------------- <br /> -- -- --- <br /> OFFICE-(209)847$157 1 1� 'Q <br /> FAX -(209)947-7744 PH# {"-g__ _.--�S I L CONTACT ---- V AIL <br /> --- --------- <br /> CALIFORNIA CONTRACTORS LICENSE#657366!CLASS"A"ENGINEERING <br /> JOB# -------------.`----1 DICE# # ------------------............... <br /> ----- <br /> �',, LAB ANALYSIS REQUFSM SITE SAMPLING MAP <br /> CLIENT CONSULTANT L L p rW23 <br /> SITE NAME PROJECT S Z p t D <br /> ADDRESS t t CITY ,7 ST dG yS V x4P <br /> SAMPLER SIGNATURE 14 Ll VT <br /> SHIPPED VIA WAYBILL# <br /> ANALYSIS BY TURNAROUND TIME Q DAY �• Ra1 w w p�q W <br /> SAMPLE LD/ DATE TIME CONTAINERS TYPE MATRIX i ijl ldlf ilIIIlEi Il i'1, '','!I REMARKS I LAB I D <br /> 1) b <br /> Z) PAIA ao I a I I � -fi D LVA <br /> 3) + 10-7TT <br /> 4) 1 V <br /> s) S <br /> 6) IMJ04+ <br /> 7) _ ^ It <br /> ]0) <br /> [J4) <br /> DATE! <br /> RELINQUISHED BY RL�IVED BY '' � /,�� SAMPLE INTEGRITY I CONDITION <br /> ( amu f <br /> r (SI�TURE) RECEIVED COLD&c INTACT/ YES NO <br /> DATEITBa DAM ITUa <br /> FM,Mft4QUL%0M <br /> M�BI _ RECEIVFDBY AIR BUBBLES IN V 0 A 5 ! YES NO LINE(S) <br /> ! (SMATUIQ r CUSTODY SEALS INTACT ! NO ( ! NIA <br /> DATE(T7ME <br /> BY Rii(bTYFT?BY PR.PSERVATIVESUSE,D J YES NO <br /> ! (5¢7NATURE) TYPE OFy <br /> NOTE PLEASE ARCHIVE THE SAMPLES SUBMITTED FOR THE FULL.HOLDING TIME ALLOWED UNLESS OTHER ARRANGEMENTS ARE MADE (MTBE,T.A M E,E T B E,D I P E TBA) <br /> B B =BAII-M BLANKS COLLECTED IN THE FIIJ-D F B =FIELD BLANKS COLLE=IN THE FIELD <br /> PINK FIELD COPT WHITE R I ELLIA% TO LAB "ITH SAMPLES I ELLOM RFTURN TO(LIENT K ITH RESULTS DF 1 TI CH( 0 C FORAL 98 <br /> + � 1 <br />