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-- ANALYTICAL REQUEST/SAMPLE CHAIN OF CUSTODY— LAB TRACKING # <br /> RECORD OF DATE RECIEVED <br /> LAB INVOICE TO -- <br /> DEL-TECH GEOTECHNICAL SUPPORT SERVICES <br /> - <br /> 10624 OLIVE AVENUE,OAKDALE,CA 95361 .V h....... .)- Lb - I <br /> OFFICE-(209)847-8757 9�g k <br /> FAX -(209)847-7744 PH# ( ----- --•)...... ........-. CONTACT Lh .------------....-----.......---.................._. <br /> CALIFORNIA CONTRACTORS LICENSE#657366/CLASS"A"ENGINEERING <br /> LAB ANALYSIS REQUIMM SITE SAMPLING MAP <br /> CLIENT ---' CONSULTANT LL <br /> SITE NAME PROJECT •w �� O.0 <br /> ADDRESS CITY ST F O <br /> SAMPLER SIGNATURE Uµ- <br /> SHIPPED VIA <AktlMTtVl WAYBILL# , wi� Q $ E■ �L <br /> ANALYSISBY TURNAROUNDTIME DAY(; <br /> SAMPLE ID P DATE TIME CONTAINERS TYPE MATRIX REMARKS I LAB ID <br /> 1) - �j - %A21111 D Ib <br /> 2) - Llb O 1 <br /> 5) Mz 3'7 <br /> ) <br /> 9) <br /> 10} <br /> 11} <br /> 12) s <br /> 13) <br /> b <br /> y /,/' ! r SAMPLE INTEGRITY/ TION <br /> RELINQUISHED91 L AEfEIVFDBI `' / + �ll�' d,� q <br /> bolf 6� / (SIGNATUREI i� ' /7,40RECEIVED COLD R INTACT I YES ) NO( ) <br /> RELINQVISHM BS ' -' /,Z ,�?? 99 ��B1 ria i- � �y AIR.BUBBLES IN V O A S r No LIN s N <br /> (S1GNA7URE] i /��✓1 CUSTODY SEALS INTACT !YES i NO f ) N/A ! I <br /> � A DATE fTIME <br /> RELINQLISF�DBS RFSEIVED111 PRESERVATIVESUSED f YES NO{ <br /> iSIGNATUM I (SIGNATURE) ! V 'L- <br /> \(ff PLEASE dhVE THF SAMPLES Sl BMTITED FGR THEFT LL HOLDING TIML ALLOWED l NLESS OTHER ARRAN S ARE MADE * (\I T B E T A M I; E T B F,DIPA) <br /> $B =BALI FAWNKS(Of 1 FC-MD IN THF FIQ D F B =FILLD BLANKS COL LF('I•F_D IN TAWLD 0 <br /> Pikw vninfTIP\ UR1T37 A A FI1(M Tl11 A A IAITR gVL4P1 F¢ %FI1(11% I2FT1 R\TnfI1 NTNAMI UPU iTC hFi T}1-11011 C MUM <br />