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ANALYTICAL REQUEST/SAMPLE CHAIN OF CUSTODY-- LAB.TRACKING #: <br /> RECORD <br /> OF DATE RECIE'VED: <br /> A- <br /> f _T <br /> LAB.INVOICE TO: <br /> IDEL-TECH GEOTECHNICAL SUPPORT SERVICES <br /> 10624OLIVE AVENUE,OAKDALE,CA.95361 MNTACT: <br /> OM <br /> -(209)947-8757 <br /> FAX -(209)947-7744 <br /> CALIFORNIA coNTRACTORS LICENSE 0 657366 CLASS"A"ENGUiEERING JOB 4 ---INVOICEf <br /> ly �; P,l ANALYSIS REQUESM SITE SAMPLING MAP <br /> CLIENT-Frrvt�e irkarm CONSULTANT: J rA aF as <br /> "J <br /> SITE NAME: PROJECT: <br /> I&-krq Oe-ont ,ZJA) <br /> ADDRESS rrrA Crry:'FCtXQC <br /> SAMPLERC',SIGNATURE: o - ; A <br /> omjojDr, sp � <br /> SPED VIA: )NAYBELL = <br /> ALYSIS BY: TURNAROUND TPAEZS$r, rijQ DAY( <br /> REMARKS LAB.LD. <br /> SAMPLE I.D. DATE TIME CONTAINERS TYPE MATRIX <br /> Ltr__ <br /> 3.) co C.-ro <br /> 4.) <br /> I H <br /> 7.) <br /> 8.) - b <br /> 9.) f 4115,5- <br /> 10.) --1531 <br /> 12) SS) k -TD <br /> .IN 6ZA& <br /> 14) <br /> DATE ITD� <br /> RECEWED Ryi SAMPLE INTEGRITY/CONDITION <br /> R"(AilsHm BY; <br /> RECEIVED COLD&INTACT i YES,-r') NO. <br /> IGNATW'l-) 69&2_0 <br /> Le (S - T)ATE I TIME <br /> DATEITIMbm ES ( ) NO( LINE(S)#. <br /> AIRBUBBLESINVO.A.'S <br /> mDdQUISHED DyERECOVEDBY: <br /> CUSTODY SEALS INTACT I YES L,� No f i NIA <br /> A-W <br /> QQAJJ�RE) I alt (SION RE) 1WEiTUF PRESERVATWES USED / YES e-l-NO, d <br /> RECEIVED <br /> RELlNqJL%W BY: <br /> , . , I PEOFM FRVAIP;E(Sj <br /> (snNA-niRE) Lx <br /> t MATU <br /> ATUREi * (M.T.B.F.,T.A.M.E..E.T.B.E.,D.I.P.F.,T.B.A.) <br /> HOLDING TIME ALLOWED.UNLESS OTHER ARRANGEMENTS ARE MADE. <br /> NOTE p(EASE ARCHIVE THE SAMPLES SUBMITTED FOR THE FULA. F.B.=FIELD BLANKS CoI.I_FCTU)IN TID:I II <br /> B.B.=BAILER BLANKS COLLFCTED IN M.FIELD. -RETURN TOCLIFNTWITII RESULTS DF I. C.O.C.FORM 99 <br /> PINK-FIELD COPY WFIlTE&VELLOW-TO LAB.WITH SAMPLES <br />