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r rr r r r r r 7,SAMPVG <br /> ANALYTICAL REQUEST' CHAIN OF CUSTODY-- LAB TRACKING # <br /> RECORD i Off' � DATE RELIEVED ------------ - <br /> LAB INVOICE TO <br /> DEL-TECH GEOTECHNICAL SUPPORT SERVICES 15255-.,-, `y <br /> 10624 OLIVE AVENUE,OAKDALE,CA 95341 <br /> OFFICE-(209)847-8757 PA# ( ---)-saw-wCONTACT -- 4_ <br /> FAX -(209)8474744 <br /> CALIFORNIA CONTRACTORS LICENSE#657366!CLASS"A"ENGINEERING OB# -------------INVOICE#--- -- ---- O <br /> i i,ns, <br /> ( I fl li 11 i 11 33141E€ti i�`I'!'ilI'If €iil'fif ill' LAB ANALYSES REQUESTED r SITE SAMPLING <br /> ! ;i'Ifll' "=1111 Ifni ull'I s I'll j 1°"11111 I it I u!I!II 111111 I!Ifl 13,!il'lllllllt l �I c II1s IilI 6i,I,I,,111111 7,, ( MAR <br /> II �nPli I'€Illfiffl`'I litl!�t t!4alE�E�{1!1 fl l II JI u I f E,EF,I„i !,!�I[l l,l lug, 6 il,�,�„...! � V <br /> CLIENT CONSULTANT F R aE <br /> aw Z, v <br /> SITE NAME L D PROTECT <br /> ! �S O <br /> �6 <br /> ADDRESS i CITY ST ` <br /> 0 v �4- rn <br /> o d H <br /> r <br /> SAMPLER SIGNATURE � !4 <br /> Z7 A � ado $ � °�° °�° F. � .-�■�Z <br /> SHIPPED VIA_ WAYBILL# �' .4 p[ CG a <br /> ANALYSIS BY TURNAROUND TIME DAY W °O W w <br /> III � It t`II!`I'I''t i'I I lll��li i!I!!'I !il14'I°,illll!�"II'' REMARKS/LAB ID <br /> !3 TIME CONTAINERS TYPE MATRIX I,.I I ( I €E f E°f° i <br /> SAMPLE I D 0 DATE <br /> 1) <br /> 2) b <br /> 3) i A- <br /> I <br /> - 4) <br /> 5) T\4AA <br /> 6) <br /> 7) NOMA- <br /> 8) e twl V <br /> 9) <br /> him <br /> tD) <br /> tI} <br /> tz) <br /> t3) <br /> Ia) <br /> 15) DATEr74sE <br /> � Rl7' <br /> SAMPLE INTEL= Y!CONDITION <br /> RECEiVF.D 8] � � � f% <br /> RELINOUISI®EY .` <br /> r'� (57�NANAET ��!'�l'w -� y -� �;f f RECEIVED COLD&1NO ( ) <br /> j DA1E11TAE <br /> I AIR BUBBLES INV O A S ! YES NO LIMB 5 N <br /> Rr+-F]yFp BY <br /> RELINQUISHED Bt 1 CUSTODY SEALS INTACT 1 YES E NO( ) N!A ( ) <br /> 1 (ssan[aTURD OA'TE 17➢4[E <br /> A PRESERVATIVES USED 1 y ES NO { <br /> REa[VED a) I <br /> a>t wQulstrtv etTYPEp F V IY <br /> 1 <br /> 1 (SIGNATURE)A (I44TBE. TAME I:TBIs uIPE TBA) <br /> NOTE PLEASE ARCH[VE THE SAMPLES SUBMITTED FOR THE FU[L HOLDING TIME ALLOWED UNLESS OTHER ARRANGEMENTS ARE MADE <br /> B B =BAILER BI ANKS COLLECTED IN I}IH RF-LD F B =FIELD BLANKS COLLCC-1 LD IN TI IF I ILI D DE I Ti C11 C 0 C I`ORNI 98 <br /> PINK FIELD(Op1 WI[ITF R)hl!Ot5 TO LAB W IT}i S4A1P!ES <br /> {FI LOVA RETURN TOCLIF.NT%11TO RESULTS <br />