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r <br /> mot— <br /> r. <br /> -- ANALYTICAL REQUEST I SAMP CHAIN OF CUSTODY-- LAB.TRACKING #'_:------ <br /> RECORD OE �_._�' °, i f- J S •' r ,` r� DATE RECIE ED: <br /> r� <br /> LAB.INVOICE TO: --- _ --- " 4. _ ------ ��."f_3l -!_ - ------- -^-~ <br /> DEL-TECH GEOTECHNICAL SUPPORT SERVICES ;l 1 „` 4; __-------- <br /> - <br /> 1 <br /> 10624 OLIVE AVENUE,OAKDALE,CA.95362 ---- ------ <br /> OFFICE (209)847-9757 <br /> r: ^^ _ r _.�.__°_�_.__ L =...... <br /> _-- --- --------- <br /> PH.# (- -= � - CONTACT: - - .' <br /> FAX -(209)847_7744 -- <br /> CALIFORNIA CONTRACTORS LICENSE#6573661 CLASS"A”ENGINEERING O # _~_--__-__--�---^I OICE#------------------------ P_O.# ---�-=�= ----- - - <br /> !�i�I -°-ji!'k � I i rrr r ,j rrr ail,-i' rE` ILII 1€'i, } I.IIi. LAB_ANALYSIS REQUESTED(PLEASE PRINT) SITE SAMPLING MAP <br /> _ 7f ¢J®tlftl <br /> CLIENT: \.j 3 1 a CONSULTANT . '` <br /> SITE NAME: PROJECT: <br /> r-e • _ <br /> ADDRESS: '€ ' "r 4 ( i= CIT2: n .ti; m ST.: 1 ,� <br /> ~F <br /> SAMPLER SIGNATURE: f ;s, I <br /> SHIPPED VIA: } f Q WAYBILL`#t -.-�R. � <br /> �-•- <br /> ANALYSIS BY:�L, � _ �' ( "}C� TURNAROUND•/"IMF:: ")`� �'Y.' N DAY(S) <br /> i�(�::� � <br /> ral: REMARKS/LAB.I.D.#'S <br /> I i y SAMPLE LD-# 1 DATE TIME CONTAINERS TYPE { MATRIX , <br /> 1'.) i� .dF), ly��` i c. <br /> o�f �, ,. •,, ( ,f. r <br /> Rib) I <br /> 2.} �il��� `h '�^^ � (moi � r..� �,q � 1 j � �"{y .-•Y' i T`j �� 3._��..... <br /> �-s— U ,` " <br /> 12.) <br /> 14.) <br /> ]5.1 <br /> x DATErT[MB. nAiTIME SAMPLE INTEGRITY/CONDITION <br /> RECIIVED BY: <br /> RELINQUISHED NOUJSHBD BY: `� I' 1 r,-. �).(^ j J fI,•� w> > f l.'� •..� . <br /> r RECEIVED COLD INTACT ! YES r NO <br /> r $ !fir (SIONATUR)3) r� <br /> 'y' ,{f 'imr i '> ,3,! <`$? 4 DATEITIMET I' LIN S p- <br /> DA I MH / 1 <br /> RELINQUIsftEDBY: i` ,..i , ._.- -..; �� } / rt RELTWEDBY: l JJ [ j f -.,.�' AIR BUB13L�.S IN V.O.A.'S !YES NO (�- <br /> J{r I U. 3,._ ! fv i •. CUSTODY SEALS INTACT /YES (,( NO( N/A i <br /> DATE I T[ME DATH,"11W I <br /> RELTIVED BY- PRESERVATIVES USED I YES I -'' NO { <br /> RELINQUISHED BY: <br /> I (SIpNA7URE1 r V <br /> NOTE:PLL'ASE ARCHIVJ3 THE SAMPLES SUBMn-MI)FOR THE FULL HOLDING TIME ALLOWED,UNLESS OTHER ARRANGEMENTS ARE MADE. <br /> B_B.=BAIL,FR BLANKS C'OLLECT'ED IN THE FIELD. F_B_=FIELD BLANKS COLLECTED IN THE FIELD. <br />