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7.41 <br /> -- ANALYTICAL REQUEST/SAMPLE CHAIN OF CUSTODY — LAB.TRACKING #: --•-----7----•---•----•--- <br /> DATE RECIEVED: <br /> RECORD � OF •=---•=-------•:-- -----•-._ <br /> ' t L& <br /> -------------- <br /> DEL-TECH GEOTECHNICAL SUPPORT SERVICES <br /> LAB.INVOICETO: -------------------------------- <br /> --------------- <br /> 10624 <br /> -- -• ----- <br /> 10624 OLIVE AVENUE,OAKDALE,CA.95361 <br /> OFFICE-(209)847$157 <br /> FAX -(249)847-7744 PillCONTACT:--•--• ------------------------------------------------------------------ <br /> CALIFORNIA CONTRACTORS LICENSE#6573661 CLASS••A"ENGINEERING -INVOICE# P.D.# ---------•------•- - •' <br /> OB# --- - <br /> LAB.ANALYSIS RESITE SAMPLING <br /> MAPQUE4TED <br /> CLII?NT: CONSULTANT: .L r s' w i l .!• t vy H <br /> SI E NAME: PROJECT: _`� t ' r, v ?' t:r, ^• >; <br /> 44 r, f, <br /> ADDRESS: s-T,�• " . �:5% i =zti� CITY: a C-#•-f' V ST.: �>` [� 0 � <br /> C. <br /> SAMPLER SIGNATURE: =r I µ E:! o $ `� d m t _ A, i ,`°V <br /> SHIPPED VIA: rn- ,.);e; ;,;t71 WAYBILL 4' �, <br /> �F'+�f i 1, �` �`' TVRNAROI3ND TIME: '`rF ¢ iii i i i `i DAY(S) Ir W w opo W W �{�:= <br /> ANALYSIS BY: <br /> -,1- <br /> SAMPLE LD.0 DATE TIME CONTAINERS TYPE MATRIX ' REMARKS/LAB.I.D. <br /> 4.) '��r.i"�} it ! t •i ' ! ! <br /> C 1 <br /> 7.) `_tiA s — i ry I tti <br /> so <br /> 10.) <br /> 12.) �)s•1�'' �:�r)t�-, ���.�.. � s�.' ; .l <br /> 13.) <br /> 14.) <br /> 15.) ,fir <br /> oATe r» SAMPLE INTEGRITY/CUND1TlON <br /> � { h RECEIVED BY: "� - %.%..r <br /> RaIINQU1SPEDE BY: '" �" "f <br /> .- Y1 111!•- z i; � rD� ,''"s-'j'�-yr''• _ '. moi <br /> �{f R i - RECEIVED COLD&INTACT ! YE5 f/1 ti0 [ 7 <br /> S A <br /> pnr[tr[E L[NEfS #- <br /> RL].Cv`QV[SFB:D B5 RECEIVED BY: AIR 9UBHLFSIir'Y.O.A.'S ! YES Z Ev0 f <br /> .t- �'• - -.`c :,',. - f(.'/�r•j r`� (s1CNA'fVREI r �• _ - ,�a,'_ i/, it i ! Y'ES.f I NO f l VIA f i <br /> �! - ,s.. Y- CUSTODY SEALS INTACT I <br /> V �4 r DA3EfiL4tE f <br /> A r RECEIVED BY; PRESERVATIVES USED I YES NO f <br /> RELLNQI!FS]�D BY: I v <br /> _ 1 (SIGNATURE) 1 O VA 5: '-'t--'' <br /> NOTE: PLEASE:ARCIIIVE THF.SAMPLES SUBMITTED FOR THE FIU.I.1101.DING TIME AIL.OWED,UNLESS OTkIER AKRANGEMFNTS ARE MADE (M.T.B.E..T.A.M-E..E.T.B. <br /> b;.. <br /> B.B.=BAILI-A BLANKS Colli-CMD IN TI IF 110,0). F.B.=FIELD BLANKS C0L1.EC'Ell)IN TIIIi FWLD. <br /> PINK-FIELD COPY WHITE Y'L:LL[f1Y'•T[11.4B.WITH SAMPLES -RETURN TO CLIENT WITH RESULTS DF:1.•T[Ckl C.O.C.FORM 78 <br />