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-- ANALYTICAL REQUEST I SAMPLE CHAIN OF CUSTODY-- LAB TRACKING #ia --•-------------- --- <br /> RECORD — OF DATE RECIEVED - --a2#`_(g <br /> ot <br /> DEL-TECH GEOTECHNICAL SUPPORT SERVICES LAB INVOICE TO ---- Q Q LC11- ----- cain`�L� ----------____ <br /> ID624 OLIVE AVENUE,OAKDALE,CA 953611 — - ""'" �- -' "'" 5`�----------------- <br /> OFFICE-(209)847-8757 PH# P09- �f- CONTACT -- -~ I_J- - ------FAX -(309)847-7744 -- -— <br /> CALIFORNIA CONTRACTORS LICENSE#6573661 CLASS'A ENGINEERING <br /> OB# - --.INVOICE# - <br /> I LAB ANALYSIS REQMTED SITE SAMPLING MAP <br /> F <br /> CLIENT <br /> CONSULTANT <br /> CONSULTANT �' F <br /> SITE NAME PROTECT I C) s <br /> C7 �7 <br /> z <br /> ADDRESS CITY ST d ul <br /> SAMPLER SIGNATURE Q e (q N 00 <br /> L7 A on A 00 w <br /> SHIPPED VIA WA ILL# �1 dC d C $ d d F <br /> ANALYSIS HY TURNAROUND TIME DAY(S) w z <br /> SAMPLE I D f DATEJ TIME CONTAINERS TYPE MATRIX i I I Ii I it ll'f ' i I,I'II I'll '13 I,II REMARKS I LAB F.D <br /> I I�i I u l T i l ILII l'I�I �liii3 I t <br /> I} ) <br /> 2) <br /> 3) <br /> 4) <br /> 5) � <br /> 6) .. <br /> 7) <br /> 9) <br /> 10) <br /> 11) <br /> I2.) <br /> 13) <br /> 14.) <br /> 15) <br /> DATE1T&M <br /> RcCEIVEDBY ,/ Tsfs-- SAMPLE INTEGRITY/CONDITION <br /> REI.240CnstEr at <br /> q r {slQHAIl1RE� InZ RECEIVED COLD A INTACT1 YE5 ) NOfsMA1tMM el� ( ) <br /> P.ELVQUWIED 93 !� Ri'''m BY 6f.�Y o a AIR BUBBLES iN V O A S / YES ( NO LINEIS Y <br /> 1_ p (SMATURE) S r CUSTODY SEALS INTACT I YES f NO f ) NIA f ) <br /> A f DATE/TMEREUNQUISIED$] R60=11'FDaIL=RV6jfVb(Sj <br /> S USED 1 YES NO [ <br /> / {s10tLlillRP) r <br /> NOTE PLEASE ARCHIVE THE SAMPLES SUSMrFMD FOR THE FULL HOLDING TIME ALLOWED UNLESS OTHER ARRANGEMENTS ARE MADE � (NI T BZ,TA M E,E T B E.,D I.P.E,T BA) <br /> B 13 =BAILER BLANKS COLLECTED IN THE FIELD F B =FIELD BLANKS COLLECI M IN THE FIELD <br />