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- ANALYTICAL REQUEST I SAMPLE CHAIN OF CUSTODY-- LAB.TRACKING #: -- ---------I=-�--= <br /> 'cam • <br /> RECORD OF DATE RECIEVED: --- ------=-'-=--:-. ------- <br /> I t <br /> -- ���1 t- --- -i- � <br /> �EL-TECH GEOTECHNICAL SUPPORT SERVICES LAB.INVOICE TO: <br /> --------- - •••- <br /> 10624 OLIVE AVENUE,OAKDALE,CA.95361 ----------------------------------------------------------------------• ......- <br /> OFFICE-(209)847-8757 <br /> FAX -(Z09}847-7744 PH.# (- -=--t..-?---------------------CONTACT: 1" - <br /> CALIFORNIA CONTRACTORS LICENSE#6573661 CLASS"A"ENGINEERING <br /> OB# ---------•-----------1 OICE#----- -------------------P.O.# --------------------------------------.. <br /> SITE SAMPLING MAP <br /> LAB.ANALFSIS REQUESTED <br /> (!700.159 <br /> CLIENT: OL `� CONSULTANT: tG-�l L\. p si 1Y y m <br /> 1-! .__j <br /> SITE NAME: PROJECT: S7,"�►h1 2 �,; 8 �11 <br /> ADDRESS: (, S CIT V: ' ST.: ► oa >1 0 <br /> SAMPLER SIGNATURE: j C s <br /> SKIPPED VIA: � � WAYBILL#: �•-�"� v 0,0 � <br /> ae, <br /> ANALYSIS BY: V_Q1S3� TURNAROUND TIME: (4' '( s DAYS �: tzl o$o W W c <br /> SAMPLE I.D. bATE TIME CONTAINERS TYPE HAWK ! REMARKS/LAB.I.D. <br /> .3 It 311 <br /> -3 13 <br /> 5.) m-IN" 1 :J <br /> 6.) rllo,�- <br /> 6.) <br /> 9.) <br /> 10.) <br /> 1 l.} <br /> 12.) <br /> 13.) <br /> 14.) <br /> 15.) <br /> A n DAlE!74NE <br /> G�OUISHEDBY: �, 3� RBCErvEDBY: SAMPLE INTEGRITY/CONDITION <br /> {SiONANRE) �� ' ' r"" ' -' r�` RECEIVED COLD&INTACT 1 YE E NO f 1 <br /> DA� TIME <br /> RELNQUISIEDBY: _*� f =, ///.3 a�ive�BY: �`+1l ° ,� �jf AIR BUBBLES INV.O.A.'S / YES NO LINESR-. <br /> . . l . 5 / / <br /> I l cl j 9� (SIGNATURE) , ) �i 1 r' �, �i f ~�1�^l / �! CUSTODY SEALS INTACT / YES ( ) NO f f NIA 00) <br /> A + <br /> DAWI-11ME <br /> LRERLINQUISM BY; RECEIVED BY: PRESERVATIVES USED I YES C,,Of NO f <br /> r 1siDNATURar r v S <br /> NOTE: PLEASE ARCHIVE THE SAMPLES SUBMITTED FOR THE FULL HOLDING TIME ALLOWED,UNLESS OTHER ARRANGEMENTS ARE MADE. � (M.T.B.E.-T.A.M.E.,E.T.B.E.,D.I.P.E.•T.B-A.) <br /> B.B.=BAILER BLANKS COLI.CI•ED IN THE FIELD. F.B.=FIELD BLANKS COLLECTED IN THE FIELD. <br /> PINK-FIELD COPi' WHITE a YELLOW•TO LAB.WITH SAHPLFs YELLOW-RETURN TO CLIENT WITH RESULTS DEL-TECH C.O.C.FORM 99 <br />