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9902000097 DEL-TECH-SVC <br /> -- ANALYTICAL REQUEST/SAMPLE c #: <br /> RECORD OF 1 : ------- --- - <br /> LAB.INVOICE TO: t/ �-'- -_6-u`_'_ ..-------�--_._...... <br /> DEL-TECH GEOTECHNICAL SUPPORT SERVICES `&- <br /> l � --------�--- <br /> 10624 OLIVE AVENUE,OAKDALE,CA.95361 ---- -D J- f-,.6L^`�{---------- --- -----.._------p---1)--------__.__------------- <br /> OFFICE-(209)947 8757 `"I 1 1 J� ---f---p i_"_'_'ry -- ------ <br /> FAX -(209)847-7744 PH-# (----------)------- ------CONTACT: --- f <br /> CALIFORNIA CONTRACTORS LICENSE#657366/CLASS"A"ENGINEERING FF <br /> OB# ------ INVOICE#--._________-_-P.O.# .---------__-- <br /> IXu'."I,I� `I I€,,t!IIIIIIIillllII � <br /> t „�'l� ,t1ilDl'Ili,l,i 1�;�i I I'll''ILitI'i �t!.I;' I,I!II,;IILI��.''` I LA&ANALYSIS REQUESTED SITE SAMPLING MAP <br /> uIuIIJI,J,;,. i 11 L.. <br /> CLIENT: L CONSULTANT: �+ <br /> RO .W �n l 1" U� �_ <br /> SHE NAME: JFGT: � <br /> � � � C9 r4 <br /> ADDRESS: 1`�G IG-a CITY: 4 ST.: ' ;I d4 F <br /> SAMPLER SIGNATURE: L ` p <br /> WAYBILL#: <br /> SHIPPED YIA• � <br /> ANALYSISBY: TURNAROUND TIME: DAY(S) F+ E+ F W w eNo W W <br /> REMARKS/LA,8.LD. <br /> I SAMPLE I.D.! DATE TIME CONTAINERS TYPE MATRIX I�,ll I I I[l,I :I�IIII, l.,lllli €f IIlI1 i�I l 3, I;":{I [It,lil c€.I ,1111 <br /> tP ?i <br /> > i <br /> t S . <br /> .} <br /> L n Vb-)Qr Lp <br /> 12.} <br /> 13.) <br /> 14.) <br /> 15.) <br /> Ra INaU=$ B} 1 KI6 <br /> REtEiVED BY: DATE r' SAMPLE INTEGRITY/CONDITION <br /> ;SIONA-WRE) r RECEIVED COLD&INTACT I YES NO ( } <br /> A DA"iE!TLti[S <br /> RE.INQQISH®BY; RECEIVED BY: AIR BURBLES IN V.O.A'S ! YHS ( NO LINE(S)N- <br /> r ;SIONA-MM r CUSTODY SEALS INTACT I YES ( 1 NO( ) NIA £ <br /> A I DATE r TAME <br /> RE.INQUrSHM BY: RfatV n BY. PRESERVATIVES USE[) I YES NO [ <br /> r (SKINATURE) <br /> NOTE: PLEASE ARCHIVE THE SAMPLES SU8MTTTED FOR THE FULL HOLDING TIME ALLOWED,UNLESS OTHER ARRANGEMENTS ARE MADE. (M.T.B.F.,T.A.M.E.,E.T.B.E..III.LP.E..T11-A-) <br /> B.B.=BAILER BLANKS COLI.ECTED IN THE FIELD. F.B.=FIELD BLANKS COLLEC fE D IN TIE RELD. <br /> PINK-FIELD COPY WHITE&YELLOW•TO LAB.WITH SAMPLES YELLOW-RETURN TOCLIENTWITH RESULTS I)FL-TKCH C.O.C.FORM 98 <br />