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�. <br /> -,. <br /> ANALYTICAL REQUEST/SAMPLE CHAIN OF CUSTODY LAB.TRACKING #- --------------------------- <br /> RECORD OF DATE RECIEVED: J-eIt'r <br /> [120624EL®TEcx GEOTECHNICAL SUPPORT SERVICES LAB.INVOICE TO: ---`---------=-=------------------_...---�-----•-=-�---�,---------------__-____-__------ <br /> OLIVE AVENUE,OAKDALE CA.45361 B�� - z'�_ � � � � � '�� �T 13 , <br /> 3 <br /> ---------------------------- - k <br /> ICE-(209)847-8757 -- <br /> FAX -(209)847-7744 <br /> ONTACT- <br /> v'b <br /> CALIFORNIA CONTRACTORS LICENSE#657366/CLASS A ENGINEERING <br /> .., <br /> OB�Yxa."# �O W"d---w–�ad_r�Oa-------- <br /> i----o�q{��C-a,:-,-I OI <br /> EF�"#--t3- <br /> -� <br /> - <br /> -----------------•--P.O�..#�r.M <br /> OrR <br /> _? <br /> _ <br /> ---- <br /> -—------ <br /> ------- <br /> SITE SAMPLING MAP <br /> LAB.ANALYSIS REQUFSTEU <br /> CLIENTCNSILANT: <br /> SIE NAME: PRIEG : R. ml . <br /> ADDRESS CITY: <br /> 01 <br /> SAMPLERSIGN URE: <br /> SHIPPED VIA: WAYBII #: 11ANALYSISBY: l TUNROUNTIME: DAYS <br /> SAMPLELD. DATE TIME CONTAINERS TYPE MATRIX <br /> RLB.MLDy --- <br /> W <br /> 9.) <br /> I <br /> 12.) <br /> 13.) <br /> 15.) <br /> 9 <br /> p <br /> Re1:rpl1SHED � �� � k � DA7�rTIMH <br /> BY: 1 v ;a Rrcvxus�. ¢ f SAMPLEIN7EGRITY/CO DI ION <br /> f • . '"'': - T' `" (SIGhIATl1RE( r-''' .�r r�P, tfj .ujf''-'�..:», ,,, ''J'`I RECEIVED COLD&INTACT I YIIS w°'1 No ( ) <br />� RELI NQIIISHM BY: "N= �✓°1/ "" 1 ,,,� 1 RECEIVED IM f• ; DATE/TIME <br /> AIR BUBBLES IN V.O.A.`S ! YHS I NO ( LINES #- <br /> ! JSIGNAIURP <br /> CUSTODY SEALS INTACT ! Y"ES( X.NO( ) NIA ( <br /> Rer.w rs -• "'- E �f 'Da�iT¢nt: <br /> RF.CE.1VEd BY: �• w i j 1 Im <br /> ..-r PRESERVATIVHS USED ! Y'ES NO <br /> .- � -t.�1 45[QNA'CURE)N � C.' �' L�.�: ✓.c.�.- -/r �f�' I�� 1,7eo-�� <br /> NOM: PLEASE ARCHIVE THE SAMPLES,SUDKIM[FD FOR THE FULL HOLDING TIME ALLOWED,UNLEss O'I'HF.R�APPANOEA7eN'TS ARE MADE. j L-' (M.T.B.E.•T.A.M.E.,E.T.B.E.,D.I.P.E-T.B.A.) <br /> B.B.=BAILER BLANKS COLLECTED IN THE FTFLD. F.B.=FIELD BLAN(S COLLECTED IN THE FIELD. <br />.` nr.,v VI.,n..-.n.• ��,=.,T�v.—r,.,.. <br />