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Ir (0(0 -1 vZ UL/Y02 <br /> -- ANALYTICAL REQUEST/SAMP CHAIN OF CUSTODY-- LAB TRACKING # -- ------------- ------ <br /> RECORD OF DATE RECIEVED -� ��-_-- <br /> LAB INVOICE TO - --- t�..1,.. r. .j. ..e r.�.. - ---- -+-----..--...-...... <br /> DEL-TECH GEOTECHNICAL SUPPORT SERVICES <br /> 10624 OLIVE AVENUE,OAKDALE,CA 9536. -1. ......-- .1 --- -s�.e�- - ---- r> ....-.1..................... <br /> OFFICE-(209)847.5757 _ --- <br /> q { hU <br /> FAX -(209)847-7744 PH# P- 0... A..- 31�j CONTACT -.6V...��.---e r=tl----! <br /> ......._...... <br /> --- <br /> CALIFORNIA CONTRACTORS LICENSE#657366!CLASS"A"ENGINEERING <br /> OB# --------------------INVOICE#--- -----......_--------P O # - - - --------- <br /> LAB ANALYSIS REQUESTED SITE SAMPLING MAP <br /> CLIENT CONSULTANT %\l Pmmeer;na crI <br /> SITE NAME ( PROJECT . • • <br /> ADD , r, CITYIQ ST O <br /> SAMPLER SIGNATURE `I, 1 <br /> SHIPPED VIA e WWBILL# <br /> WW <br /> ANALYSISBY TURNAROUND TIME DAY <br /> SAMPLEI D Jr DATE TIME CONTAINERS TYPE MATRIX g11111REMARKS/LAB ID <br /> 1) <br /> 2) <br /> 3) lD h S 1 b,L+ <br /> 4) - <br /> 6) flqo <br /> 7) - <br /> 8) - �'4•cacf- do SO/u /e a,'Vh Me- <br /> 9) LrlCi IpS CcJ e re ,� <br /> 10) <br /> 11) <br /> 12) - <br /> 13) lan --1-- wo ivnA <br /> 14) <br /> 15) <br /> A DATE MAE <br /> Riz motrlsHn Bt �'{ °Bt q� �J Q fc o SAMPLE INTEGRITY 1 CONDITION <br /> fSIGNAlMnrr (SIQNAnMEI !� / / D+z RECEIVED COLD&INTACT ! No ( 1 <br /> RA uaQu35»n Bt RECEIVED Bt ?, �� AIR BUBBLES IN V O A S I VES NO LINES # <br /> ` 11,1417— fSIGNAitIREI CUSTODY SEALS INTACT !YES fe-) NO! NIA f ) <br /> A I DATE/TARE I <br /> RELNQUISBEDBt RECEPIDBt PRESERVATIVES USED / YES ! NO <br /> I (SIGNATURE) rTYPEOPMQValMal <br /> NOTE PLEASF ARCHIVE THF SAMPLFS SUBMITTED FOR THE FULL HOLDING TIME ALLOWED UNLESS OTHER ARRANGEMENTS ARE MADE * (M T B h,T.A M.E,E T B E,D I.P E TBA) <br /> B B =BAILLR BI ALN KS COLLECTED IN THE FIELD F B =FIELD BLANKS COLLECTED IN THE FIELD <br /> PINK FIELD COP) K HITE R 1 ELLOIN TO LAB%ITH S&MPLES '1 LLLON RETURN TO CLIENT A 1TH RESULTS DI I,TF(11 C 0 C FORM 99 <br />