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r ■■� � �3I c <br /> -- ANALYTICAL REQUEST/SAMP CHAIN OF CUSTODY-- LAB TRACKING # I <br /> i <br /> RECORD � OF DATE RELIEVED ------------------- <br /> [LAB INVOICE O �L 6&1�� � <br /> DEL-TECH GEOTECHNICAL SUPPORT SERVICES ''--'--�'-'—'-....""-""'"-y '�' """"" "' <br /> 19624 OLIVE AVENUE,OAIWALE,CA 95MI 1 'ate ' <br /> OFFICE.(209)847-8757 -------�.....----- ---- <br /> FAX -(209)847.7744 # ( ---- - CONTACT — ---—------.----. <br /> CALIFORNIA CONTRACTORS LICENSE#6573661 CLASS"A"ENGINEERING M I <br /> ,a n,'li ' 'I I" , „ LAB ANALYSIS REQUESTED SITE SAMPLING MAP <br /> CLIENT CONSULTANT <br /> y�gg <br /> SITE NAME as"i PROJECT tt ! <br /> ADDRESSSig CITY <br /> SAMPLER SIGNATURE i "Ll 6 <br /> SIIWED VIA WAYBILL# $ m F <br /> ANALYSIS BY x t TURNAROUND I II1gE DAY(s)W <br /> SAMPIBID�R DATA' TIME CONTAINERS TYPE MATRIX I, � ,;;;I i'i"' f 3'I{ „' ;�,i'Iy „ ,I, <br /> "' REMARKS I LAB ID <br /> 147 O-t> Liv <br /> 2) T x 2ll.�19 <br /> 3) +". 'L30 A ;r t <br /> 4) -� 0 <br /> 7) <br /> 8) <br /> 9) <br /> 10) <br /> 11) <br /> 12) <br /> 13) <br /> 14) <br /> )5) <br /> RELINQUIS1ED91 ; .. RECEIVED 135 } �" _ '` 1. SAMPLL'INTEGRI /CONDITION <br /> (SIGNATURE) RECEIVED COLD&INTACT /YES e) NO ) <br /> r �t r naTRrT� <br /> u>:I.[rrQulstffDsti � fl r� f � �,�,il= Iz�1vFDst �—'?� <br /> AIR BUBBLES IN V O A'S I YES NO LI S # <br /> (MNATUM �"`� J TI G I ts1CINATURE1 /, :-b[ r r(, 1 'e a # CUSTODY SEALS INTACT If YES <br /> 1 <br /> RFIIHQu[s: vsrRFCCIVEll Yr , DA7Ef7➢41E PRESERVATIVES USED / YES NO <br /> WgulL I <br /> [ ISPO n nEI O V <br /> NOTE PLEASE ARCHIVE THE SAMPLES SUBMM ED FOR THE FULL HOLDING TIME ALLOWED UNLESS OTHER ARRANGEMENTS ARE MADE (M T B E,T.A,ME,E T BE,D LP E.,T BA) <br /> B B =BAILER BLANKS COLLECTED IN THE FIELD F B =FIELD BLANKS COLLECTED IN THE FIEI..D <br /> PINK FIELD CEIPI WHITE&I ELLOIN TO LAB_WITH SAMPLES I ELLOW RETURN TO CLIENT N ITH RESULTS l-TFC"C 0 f FOR M 42 <br />