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� � � � <br /> i � <br /> --ANALYTICAL REQUEST/SA L CHAIN OF CUSTODY— LAB TRACKING, L-CL <br /> RECORD OF L DATE RECIEVED <br /> LAB INVOICE TO --A ___� I __tA <br /> DEL-TECH GEOTECHNICAL SUPPORT SERVICES <br /> 10624 OLIVE AVENUE,OAKDALE,CA 95362 <br /> OFFICE-(209)847-8757 } T�� rlj <br /> FAX -(209)847-7744 PH# (- -_---} �'--x� CONTACT <br /> CALIFORNIA CONTRACTORS LICENSE#657366/CLASS"A"ENGINEERING <br /> OB# -----------------------INVOICE# P O # �,. _..........._........_ <br /> ,E[`111111 I',hlllp�h'I�gi�ii�i� € 1, `I u' I I € I'h E I�ilil3 niu�'i i i q�I"�9�PIIID'nqp"nlll I 1 p i i�P�iE III E , ,�l ink i�' <br /> „ ull € II I II,I I.II I,I kIIIIIIII,PII.I I�I,II�pIl,�il f III 'I ' II IIl,ilfl!VIII Iq I I,' �, i,u€III 4lllilffl'll'I IIII;II'�I�',��I� ,III I'III IIIfII,,l;41,1111'11„„l, lul�lllllll LAB ANALYSIS REQUESTED(PLEASE PRINT) SITE SAMPLING MAP <br /> t <br /> CLIENT CONSULTANT <br /> SITE NAME MD PROJECT 3gp 61W) NA <br /> ADDRESS CITY ST <br /> SAMPLER SIGNATURE <br /> 41 <br /> SHIPPED VIA ��-, WAYBILL.# <br /> ANALYSIS BY TURNAROUND TIME DAY(S) <br /> 'i SAMPLE LD,P DATE TIME CONTAINERS TYPE MATRIX I!E`II "il'! I'! !!' i',II`E ill`” ,'I'.I I 'I' u I <br /> I op <br /> N6+ Ik 'I�hI �� ,3 �I �°I''� hli I' ,III'III� I i I''!'.i I'I VIII I REMARKS/IAB LD ,�'S <br /> 1) +` <br /> 2) g3, pi <br /> 4) y Q 5 <br /> S) f <br /> 6 <br /> 7) <br /> s) <br /> 9) <br /> 10) <br /> 11) <br /> 12) <br /> 13) <br /> 14) <br /> 15) FT <br /> A l7TME <br /> R � ASE <br /> INOUISHEDBY �� RECEIVED BY DATE/i � t} �/ SAMPLE INTEGRITY/CONDITION <br /> r sICNATIIRE p� RECEIVED COLD&INTACT!YES NO( ) <br /> �r} DATE 17IME <br /> RII DVQUlSffFfi BY r / RECE7VED 9Y A D C� AIR HUBBIES IN V O A S 1 YES NO LINE(S) I <br /> SIGNATURk7 CC-vj f (� q CUSTODY SEALS INTACT I YES f NO( NIA <br /> DA !TIME 'DATE/TIME <br /> RELINQUISHED BY RI:COVED BY PRESERVATIVES USED / YES NO <br /> iSIGNATURE) ! (SIGNATURE) <br /> ! TYPE OF PRESERVATYVUS) <br /> NOTE PLEASE ARCHIVE THE SAMPLES SUBMITTED FOR THE FULL HOLDING TIME ALLOWED UNLESS OTHER ARRANGEMENTS ARE MADE <br /> B B =BAILER BLANKS COLLECTED IN THE FIELD F B =FIELD BLANKS COLLECTED IN THE FIELD <br /> PINK FIELD COPT 15 HITE&I ELLOW TO LAB%i M S4MPLES ]ELLOW RFTEIRN TOCLIENT%LTH RESULTS DEL TECH C 0 C FORA <br />