Laserfiche WebLink
AMI. Aft Adak <br /> -- ANALYTICAL REQUEST/SAMPLE CHAIN OF CUSTODY- LAB TRACKING # CJI ------0-- - <br /> RECORD OF DATE RECIEVED ---------------------------- <br /> -- r LL E:96 � lT <br /> PDEL-TECHGEHOTECHNICAL SUPPORT SERVICES C p <br /> 10624 OLIVE AVENUE, LAB INVOICE TO <br /> OAKDALE,CA 95361 .120-1'.."' CDS y <br /> OFFICE-(209)847-8757 PH# ( )� l.1ml <br /> FAX -{2!)9)847-7744 --------- ---- CONTACT --------------------------------------------..------------------- <br /> CALIFORNIA CONTRACTORS LICENSE#6573661 GLASS"A"ENGINEERING OB# ---INVO CE#-------..___...._....-- <br /> i, LAB ANALYSIS REQUESTED SITE SAMPLING MAP <br /> (NORTH) <br /> CLIENT L L CONSULTANT FOITM <br /> 1 <br /> SFTE NAME mC-169 PROJECT 2" . b 1� �mqp� 9 1 w Y7, <br /> t <br /> ADDRESS lL CITY b N 8T <br /> SAMPLER SIGNATURE p d m F <br /> p p R O <br /> SHIPPED VIA LL WAYBILL# cc <br /> R W d00 t d J <br /> ANALYSIS BY r*may RNAROUND TIME DAYS <br /> C]Ca�+ fr w ao Rpt W <br /> SAMPLEI D f DATE TIME CONTAINERS TIPS MATRIX n , REMARKS/LAB ID <br /> �3 8� <br /> zI L 3S �6 <br /> 3) YAM <br /> 5) L C; <br /> 7) <br /> s) <br /> I q) <br /> 10) <br /> 11) <br /> 12) <br /> 13) <br /> i <br /> 14) <br /> 15) <br /> RECErVEDg3 Da'1Er14tE SAMPLE INTEGRITY/CONDITION <br /> RELINQUISHEI?85 t �Pr� <br /> '161b (S)ONAIURE) ee Id. <br /> I RECEIVED COLD&INTACT /YES ( ) No ( ) <br /> r DATE ITIME <br /> RELINQUISRSD 85 REICEIVEI)B1 y� / AIR BUBBLES IN V O A S I YES NO{ LINE(S)H <br /> (SxrNA7TIR£) C-T� ' CUSTODY SEALS INTACT I NES ( ) NO ( ) NIA f ) <br /> A ! E DATE ITIME <br /> RELINQUISH®IIS RECEIVED B] PRESERVATIVES USED 1 NES NO { <br /> r (SIG ZATURE) rTYPE OP PRESERVAlArys) <br /> h <br /> NOTE PLEASE ARCHIVE THF SAMPLES S['BMrr-rFD FOR THE FULL HOLDING TIME ALLOWED UNLESS OTHER ARRANGEMENTS ARE MADF (M T B L TAME E T B E D I P H TBA) <br /> B B =BAILER BI ANKS COLI FCIED IN THE 1--]E1.D F B =YIELD BLANKS COLI E(TL1)IN THLFILLD <br /> PINK FIFE D((TPS M IJITF&t LLL OR TO LAB MITI]S4L MPLFS 11,1101% RFTURN TO(LIFNT V%ITH Rh Slll TS DFI,TFCI]C 0 C FORM 98 <br />