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-- ANALYTICAL REQUEST/SAMPLE CHAIN OF CUSTODY-- LAB.TRACKING #: kDj-1 <br /> RECORD OF DATE RECMTED: � � --------- <br /> :INVOICE IT <br /> B.AO �L.1'.�l..L.IY 1--�-�'���.�-l�i�a-�....._..... <br /> DEL-TECH GEOTECHNICAL SUPPORT SERVICFS LAB. <br /> T O .— ---------- <br /> 10624 <br /> ------- <br /> 10624 OLIVE AVENUE,OAIDALF,CA.95361 <br /> OFHCE-(209)8474757 (J� Q�(�] �]``�] <br /> FAX -(2091847-7744 PH.# (4 -L--)f.cq- 7.1_Is...1.CONTAC]': ...--._..Q�-_... <br /> CALDTORNIA CONTRACTORS LICENSE#657366/CLASS"A"ENGINEERING <br /> OB# _-....._._.....--INVOICE#_._......._...--------P.O.# .._-------------------- - ----- <br /> Iii,Il,. I,ImiI'I'I u;f" '.'4!!I;''I'III!lllll:1lillllllillliPq:,j:I:'il!!Il;jq;:I iji!II I-!III!Illull IMI�I�!IIGIIiIInIIIIII!IIIIII�III lllllj�lli h nl,,lilnl!IIIhIIIIIIIIIIIIIII!Hi ih1',I ill, !I id-11111 <br /> LAB.ANALYSIS REQuEsTF.D SITE SAMPLING MAP <br /> CLIENT: CONSULTANT: m <br /> 9F <br /> SITE NAME: PROJECT: E <br /> ADDRESS: I n F.' CITY: ) <br /> SAMPLER SIGNATURE- 1 r�< Lv�� 0 <br /> SHIPPED VIA: WAYBILL#: < a o ao o <br /> ANALYSIS BY: TURNAROUND TEKE: DAY <br /> !#i? SAMPLE I.D.t D'1 TE 17ME CONTAINERS TYPE MATRIX REMARK L4 B.LD. <br /> I� a z1olIg 1,ImoU <br /> a c <br /> 4.) <br /> s.y <br /> 6.) <br /> 7a <br /> 10.) <br /> T 1.) <br /> 12.) <br /> 14.) <br /> 15.) <br /> Rmffilpu[SI®BY: eBCErVrD BY: DATE(TAME <br /> Z L r q (� SAMPLE INTEGRITY/CONDITION <br /> (SKMTURE) � ` RECEIVE])COLD&INTACT! YES NO f <br /> '� DATE/71ME <br /> RELMQUf53AD BY: REfSiVED BY. AIR BUBBLES IN V.O.A'S ! YES NO I.INP S N. <br /> (SIONATUM CUSTODY SEALS INTACT 1 YES f y NO f NIA Pi <br /> A ATFIMME <br /> - REI.PMQUrSFffD BY: R8[ErvFD eY: PII:ES6RVAT1VE5 USED ! YES NO f <br /> • / (SIONATURE) `. f <br /> 1 Y <br /> NOTE: PLEASE ARCHIVE THE SAMPLES SUBMITTED FOR THE PULL IIOLDINC TTME ALLOWED.UNLESS OTTER ARRAN MP AVE.MAf)Ei 'k {M.T.9.E?.,T A.M.E.,F.7.13.N..,D.1.1'.1?.,T.B.A.) <br /> B.B.=BAILHR BLANKS COLLECTED IN THE FIFJ.D. F.B.=FIELD BLANKSC.OLLE('TFJ)IN TILE P11iLI). S <br />