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' -- ANALYTICAL REQUEST/SAMI CHAIN OF CUSTODY-- <br /> a� g LA13.TRACKING #: V" .............. <br /> RECORD OF f' `< d r :{ 7f DATE RECIEVED: a3" .--•---•- <br /> ZL <br /> LAB.INVOICE TO: .tr. .. =-�t :3 :1_ ..$--l......,__, t�r: J:1,1.5�. �.--- <br /> DEL-TECH GEOTECHNICAL SUPPORT SERVICES ; - <br /> 10624 OLIVE AVENUE,OAKDALE,CA.95361 ' I � { 1 ' t '' ; ---•--------�.. " ! :`` `WZ1, - I <br /> OFFICE-(209)847-8757 �.` I .� _................. <br /> ' ti� 1 J� <br /> FAX -(204)847-7744 PH.# (��---------.).,a:�c:_s.,a------•CONTACT: --- -...._.�.,...-• ---•--�--:_�...-------•-••--••-•-----•---- <br /> CALIFORNIA CONTRACTORS LICENSE#6573661 CLASS"A"ENGINEERING ' '<�j <br /> ` OB# I OIC E# ...�--••--........... P.O.# :..tom_ __ S r_�-[ ---------------- <br /> LAB.ANALYSIS REQUESTED(PLEASE PRI <br /> Kn SITE SAMPLING MAP I <br /> CLIENT: _. i f( i .''� CONSULTANT- <br /> SITE NAMEJ <br /> ONSULTANT:SITENAME. r J PROJECT: �I- <br /> ADDRESS:I a. f'� CITY: �.iM1.� ST.: �1 '� <br /> ' <br /> SAMPLER SIGNATURE: y' �r — <br /> SHIPPED VIA: ` YBII I #. - r.-�m. wr. ..��tr <br /> h S t ^ <br /> ANALYSIS BY: y a °,r TURNAROUND TIME:"-'— 'F .'1 DAY(S) { ' 14, <br /> SAMPLSLD.# DATE TIME CONTAINERS TYPE MATRIX I`�ili " i ,,�air <br /> a <br /> 7.) 1 <br /> a.) I <br /> 10.) <br /> I <br /> l 2.) <br /> 14.) <br /> I5.) <br /> i4 DTE{TIME f DA hAIRRUBBLESINV.D.A.'s <br /> RrtiuvolnsrlEDev: � RDCEIVEDBY: 4SAMPLBINTEGRIIY/CONb1rT10N <br /> •.. (SIGNATURE) � .wV$pCOLDAIDwI�cIlt , jUAf> IMACT! YBSNO <br /> REFNQU[SIi;=DHY -e , �f ,.�- RFiCF]VEU ev: J �' {`! ,,. 'e' ) ' 1BBLES IN V.D.A.'S ! YES NOr L[N S k- <br /> SIGNATURE pY 56AL5 INTACT ! YES 1 NO( N!A { <br /> D T�JTIMERQiHQuISI�Dsv: r ` 7 1P .. RECMMDBY: ! . PAT / RVAT[Ve5USeD ! YES ` NDfSLURATUREV <br /> rra <br /> NOTE: FLEAsl;ARCHIVE'1'tIE SAMPLES SUBMITTED FOR THE PULL HOLDING TIME ALLOWED,UNLESS OTHER ARRANGEMENTS ARE MADE. <br /> B.D.=BAILER BLANKS COLLECTED IN THE FIELD. F.B.=FIELD BLANKS COLLFCTED 1N HIE FIELD. <br />