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r <br /> ANALYTICAL REQUEST/SA MP CHAIN OF CUSTODY-- LAB TRACKING # --- . <br /> RECORD L OFtc� % (f CJ t <br /> DATE RELIEVED ----------------------------- <br /> LAB INVOVC� T ��-...... ...' L_n�F t.-� - --------------------------- <br /> DEL-TECH GEOTECHNICAL SUPPORT SERVICES �� 1}� e ` <br /> 10624 OLIVE AVENUE,OAKDALE,CA 95361 �.-----9..�--..1_bm_� ..---- _ !_SS........._- --_.... .................. <br /> OFFICE.(209)847-8757 <br /> FAX .(209)847-7744PH# (�N CONTACT <br /> CALIFORNIA CONTRACTORS LICENSE#6573661 CLASS"A"ENGINEERING <br /> OB# --------------------INVOICE#---.._..._....._ -P O # ------------- ...... <br /> LAB ANALYSIS REQUESTED SITE SAMPLING MAP <br /> CLIENT CONSULTANT !\C'e , <br /> v d <br /> SITE NAME( j(7"Af-11 MrAffc, PROJECTllt�- r. (),W <br /> ST k 0 a <br /> ADDRESS CITY C d <br /> SAMPLER SIGNATURE Q v� p o rA r a <br /> SHIPPED VIA a AYBILL# <br /> ANALYSIS BY TURNAROUND TIMAE DAYS �+ w allo W w <br /> SAMPLE I D I DATE TIME CONTAINERS TYPE MATRIX REMARKS I LAB I D <br /> 1) - { <br /> 2) <br /> 3) <br /> 4) <br /> 6) <br /> 7) <br /> 9) 1 <br /> 10) <br /> ,z) ; 4 " k 4 <br /> i <br /> 13) <br /> i <br /> 14) <br /> 15) <br /> RELINQUISHED 81 % RECEIVED III _ �A� SAMPLE INTEGRITY 1 CONDITION <br /> d' LJ <br /> Ike <br /> l <br /> -nmnr �'4� (SIGNATURE) —` / ' i RECEIVED COLD&1NTACf ! YES NO <br /> RELINQUIS D B) RECEIVED BI AIR BUBBLES IN V O A S ! YES NO 4 LIN S 8 <br /> (SIGNATURE) I I CUSTODY SEALS INTACT !YES ) NO ( ) N/A ( I <br /> RAQlQl1lSF�DB) A 7 RECEIVED B) f /1 yrLfl��JL� Jy 4 I PRESERVATIVES USED 1 YES NO <br /> TURQ '1 1 (SIGNATURE) �/ � ,�'c J /' f _l �!�}r� V S L <br /> NOTE PLEASE ARCHIVE THF SAMPLES SUBMITTED FOR THE FULL HOLDING TIME ALLOWED UNLESS OTHER ARRANGEMFNTS ARE MADE * (MTBE TAME,E T B E,D I P E,TBA) <br /> B B =BAILL.R BI AN KS COI 1 EC IED IN T111-FIELD F B =FIELD BLANKS LOLL ECI"ED IN THL I'IEI D <br /> PI l.K FIFI D(IIP) %H1TF R S FI T(1)) TO I AR R ITH SAMPLES %P 1 1 ON RETURN TO CI LENT 141TH RFSUI TS DFI,TFCH C 0 C FORM 99 <br />