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ao ANALYTICAL REQUEST/SAMPLE CHAIN OF CUSTODY LAB.TRACKING #: -------------.-------_-___ <br /> RECORD OF <br /> DATE RELIEVED: <br /> DEL-TECH GEOTECHNICAL SUPPORT SERVICES <br /> LAB.INVOICE TO: -- ..-�.'�.. _....- -...._as: ..... :... "..--------—--- <br /> ------ <br /> 10624 OLIVE AVENUE,OAKDALE,CA.95361 -- �� � .� <br /> � �:_.. ..� � � .,_ <br /> -------------- --------------------- ------------ <br /> OFFICE-(Z09) 7-8757 <br /> FAX -(209)547-7744 PH.# PO---)-`-�•-- i CONTACT; <br /> ------ -------- --------- - <br /> CALOORNIA CONTRACTORS LICENSE <br /> L 6 /CLASS <br /> I 35I 6I!CLASS <br /> I A I I ENGINEERING <br /> OB# . ..... .... . #------------- <br /> I l I <br /> ------. <br /> LAH.ANALX$iS REQUFS <br /> MPLING.MAP <br /> CLIENT: CFg � I LLUAD) CONSULTANT <br /> STIE NAME: I ! PROJECT: <br /> ADDRESS:. CITY: ST.: C7 rx <br /> m <br /> - SAMPLER SIGNATURE: �•:, <br /> SHIPPED VIA- E , — WAYBILL# "_ �•-- $ <br /> Q <br /> ANALYSIS BY:� TURNAROUND TIME: DAY(S) <br /> SAMPLE LD. DATE TIME CONTAINERS n'PE MATRIX :!I <br /> 1'I REMARKS I LAB.LD. <br /> 13-1 <br /> Z., g - <br /> [5.) <br /> -� <br /> , ' b <br /> s.) <br /> 1 9.) <br /> lo.) <br /> t 1.) f <br /> I, <br /> 12)1" <br /> l3.) <br /> 14.) <br /> RM94QIISMA)BY: �- �. RECf[VED BS': -DATT' DATElT(MH <br /> 'a �s,� v _ SAMPLfi INT G TY/CONDITION <br /> fSIGNAIURR - A (SI6NATUR6) <br /> gg� - RECEIVED COLD&INTACT ! YES NO ) <br /> RELINQUISHED B]': '�, � .' f(,'Ar'.f-LS E RECSIVED BY: ! ' r.. D�AIE/TIME LINES ♦- <br /> df ,� �✓"+ % '1 r 'fop AIR BURBLES IN V.O.A.'s I YES <br /> No a <br /> v t i Lm �F - -�r` ..�:g,✓b, [SIONATUREI !"d tI. X..r.J f '' <br /> CUSTODY SEALS iNTACT i YE NO( NIA ( } <br /> RIxINQD[sI® csl <br /> BY: t R1veDav: DATE/mm— <br /> PRESERVATWESUSED ! YES NO <br /> (SMNATURE) - Q _ V <br /> NOTE: PLEASE ARCHIVE THE SAMPLES SUBMITTED FOR THE POLI,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.D.W BAILER BLANKS COLLECI`ED IN THE FIELD. F-B.=FIELD BLANKS COLLECTED IN THE FIELD. <br /> PINK-FIELD COPY WHITE&YELLOW-TO LAR.WITHSAMPLES YELLOW-RETURN TOCF,1F,NTWITH RF_SllLTC �- <br />