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-- ANALYTICAL REQUEST/SAMPLE CHAIN OF CUSTODY-- LAB.TRACKING #: •----------- <br /> RECORD OF DATE <br /> o�RECIEVED: ----------------------.._...-- <br /> LA .I ICE TO: ~ -� VCT <br /> _ 1.1�:_J-l-� �al ----••--------•---...--• i <br /> DEL-�TECH GEOTECHNICAL SUPPORT SERVICES �y }�jr .{� <br /> 10624 OLIVE AVENUE,OAKDALE,CA.95361 ��------0.11-L�0.11 —.-- lc.`-•A - '-+'-�---------- <br /> OFFICE-(209)847-8757 <br /> FAX -{249}84T-7744 PH.# _S!.i._.J --- NTA ._------............................................ <br /> CALIFORNIA CONTRACTORS LICENSE#657366/CLASS"A"ENGINEERING <br /> OB# ............_.------INVOICE#-------------------------P.O. <br /> i:IlI li la : r: : . r ,.: i ; lr,+ I <br /> l; <br /> # -------------------------- <br /> LAO.ANALYSIS tE USESITE SAMPLING MAPfr. 'li; d';irll..rlil Irlil:'Ilil'liiiI' ......•--.. <br /> CLIENTCONSULTANT: "2- IA <br /> fNORno <br /> R <br /> SITE NAME PROJECT: l �a 9 y; <br /> ADDRESS: CITY: cjj6 0 <br /> eFd F � <br /> SAMPLER SIGNATURE: C 0 o r1i 4D rA <br /> SHIPPER VIA: WAYBILL#: ^J O a ^� <br /> ANALYSIS BY: LEr_ TURNAROUND TIME: DAY( f W w allo w w E <br /> II'II SAMPLE LD.I DATE TIME CONTAINERS TYPE MATRIX Ililhl 114iilli:ilhllll''tllllill Illilll I1IIII1; :1 li[i REMARKS/LAB.LD. <br /> r 1, - l4pAq 110A D Y r 2- <br /> 2.) <br /> 3.) <br /> 5.) <br /> 6.) <br /> 7.) <br /> 8� <br /> 9.) <br /> ID.) <br /> 1 l.) <br /> 12.) <br /> 13.) <br /> l0.) <br /> 15.) <br /> Rix woUlsrM BY: + q BY-. Dyke ltp�E SAMPLE INTEGR17YI CONDITION <br /> L v 1 fspNA� ( l�L� RECEIVED COLD&INTACT!YES ) NO f ) <br /> A DA7F ITIME <br /> RELINquisMD BY: /� ?//6/� BY-. AIR BUBBLES IN V.O.A.S 1 YES NO f 1NEf5S - <br /> V l ' ' fSp�' M CUSTODY SEALS INTACT 1 YES 1 NO f r N/A i r <br /> AwTE 1 Trtif E <br /> RELINQUIS)D:D BY; RECEM>;BY- PRESERVATIVES USED 1 YF NO <br /> ! (SKIKATUPw� ! y F1 f3I0NATjREi 11L' <br /> NOTE: PLEASEARCHiVETHESAMPLESSUBMRTEDFORTHEFULLHOLDINGTIMEALLOWED,UNLFSSOTHERARRANOEME ARE MADE. � (M.T.B.F.•T.A.M.F•..F.T.B.F..I),I-I'.E;.,T.R.A.) <br /> B.B.=BAII.F.R BLANKS COLI.F.CTCD IN 1'I Bi FICi.D. F.B.=FIELD BLANKS COLLE(TFl)IN Tf rl-FIELD. <br /> PINK-FIELD COPY WFIITE&YELLOW•TO LAB.WITH SAMPLES VE1.1.0W-RETURN TOCLIENTWITII RESULTS D}:I:TF.CII<'.1l.f'-YnR�1 aw <br />