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-- ANALYTICAL REQUEST/SAMPLE CHAIN OF CUSTODY-- LAB.TRACKING <br /> RECORDOF DATE RECIEVED: ----- <br /> +� <br /> LAB.INVOICE TO: - } - -- ....... <br /> DEL-TECH GEOTECHNICAL SUPPORT SERVICES �1 1 <br /> 10624 OLIVE AVENUE,OAKDALE,CA.95361 <br /> OFFICE-(209)8474757 <br /> FAX -(209)847.7744 }� <br /> CALIFORNIA CONTRACTORS LICENSE#6573661 CLASS"A"ENGINEERING r /� PH.# (-� -) - �NTACT.CT- � �y T '" - q� <br /> �a �i1'' d B# ------------ ........INVOICE#.f ••-•--•-•--•----- <br /> ..-..-.._. <br /> LAB.ANALYSIS ItEQUEYIED SITE SAMPLING MAP <br /> r <br /> {NORrtp <br /> CLIENT: CONSULTANT: t � W <br /> �E <br /> SITE NAME: PROJECT: E <br /> ADDRESS: CITY: ST, 9 F p <br /> SAMPLER SIGNATURE: �? <br /> SHIPPED VIA: AYBII.L#: <br /> ANALYSISBY: TURNAROUNDTEWE: DAY(S) f~` w oNo W W <br /> SAMPIE7.D.T DATE TIME CONTAINERS TYPE MATRIX I III I Ifni III I II II'i III III!I f I Iffl!`'E III'!I' I REMARKS/LAB.LD. <br /> f <br /> pup. P,Lfprqy, <br /> 7.) r <br /> 4) <br />' S.) <br /> [77,.)' <br /> E 0.) <br /> 11.) <br /> 12.) <br /> ]5.) <br /> RFI_BV(H1MM BY: RECEIVED BY: DATE(TIMF $ L I G !COND! ION <br /> Z3 (SIGNATURE, RECEIVED COLD&ENTACI ! YL'S NO <br /> RELINQUISIM BY: DATE(TMIF. <br /> RFfi.EIVF.n aY: AIR RUBBLES 1N V.U.A,'S ! YLS NO 1-INU S 11 <br /> a�Toa ( (SIGNATURE) NO ( NIA { 1 <br /> 7 CUSTU�Y SEALS INTACT 7 YEiS <br /> RELINQI1MM By DA'1f.rTrE <br /> RF.cF]vEU BY, PRESER VATEYES USED ! YES NO { <br /> ( ISIGN.4TllREI <br /> k <br /> .;4-2fL: or d <br /> NIITP.: T°f./R� ARCHIVE T]IESAMPIF,S S11RMf1-fE?D FfIRTIEE L�lll,l.H(�LIIIN(.'1'IMESnLL(IUIF�,h,UNI,F:cs nl'ISER AP' ".NINIENTS ARI..MAhh <br /> B.B.=l31 BI.ANKS C'OLLP(JITib IN TEfT-I1EiP.E), F 13.=FIELD BLANKS � 114.f lE{I.l). <br /> '1_ <br /> I <br /> L� [- . '1 .. , 'L . ,. .. _ L...._ i _�' f _ . �, f.� � � 1. ,._1. L_.j [_ <br />