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— ANALYTICAL REQUEST/SAMPLE CHAIN OF CUSTODY-- LAB.TRACKING #: ----------------------------- <br /> RECORD OF DATE RECIEVED-- ---------------------------- <br /> INVOICE TQ: __<Z)- --- <br /> DEL-TECH GEOTECHNICAL SUPPORT SERVICES '1� - ----- - ----------- <br /> LAB- <br /> 10624 OLIVE AVENUE,OAI�ALE,CA.95361 1(_fJa 1 F_ <br /> �T`T - - - --------- <br /> - j--•--�t_AL, <br /> - <br /> OFFICE-(209)847-8757 �D �^ <br /> i{ <br /> FAX - 209 847-7744 � - 11� r ------------------------------------------- <br /> � ) PH.# -- -----.-- ---- -- CONTACT: ---_••.�^-_l.�__ <br /> CALIFORNIA CONTRACTORS LICENSE#657366 if CLASS"A"ENGINEERING �� ----- <br /> I OB# -----------------I OICE#-- _ _ - - --P.O.# - ------- <br /> II �{�€r€rl II I r I€ .rlr�r'Illllil!il�liilirll,ul r r r , if. Irylll 1{{i,Irrl II it € rl r ! SII (_!€I o Ifl�. _.i <br /> .1 7� fl:II rr !r rll 1 I�Er LAB.ANALYSIS REQUESiF_D SITE SAMPLING MAP <br /> ��f,,;�,1 III <br /> �1 <br /> CLIENT: CONSULTANT: a hrws to <br /> SITE NAME: PROJECT: C� L �° <br /> ADDRESS: CI I Y: ST.: <br /> SAMPLER SIGNATURE: <br /> T� O v� Innu1 <br /> sIDPPED VIA: wAYBII,L ,� .,3 <br /> ANALYSIS BY: �' TURNAROUND TUAE: Q DAY �: �'� W T�xl S'o <br /> Tri 11 i� rurrr' rl I ! r I II I IIF'pl,y <br /> lil SAMPIFI.D.0 DATE TIME CONTAINERS TYPE MATIQIX !!ill!I,II'r1�1 i ISI°����€! !Ili 11 i±E�fl Illlilii !lill� i�rl;i Irl, <br /> 1 REMARKS/IAB. I.D. <br /> 2., 31 D <br /> 3.) I <br /> 4.) <br /> S) <br /> 7.) ka b:3 )t lip -A, <br /> 8) <br /> 9.) <br /> 1 D.) <br /> 11.} <br /> 12.) <br /> 13) <br /> E 0.) <br /> 15.) <br /> E51 ]o IiY: RE[TJYID 9Y: Jl SAMPLE INTEGRI7Y/COND111UN <br /> ky\ 17/�� (5KPlATVR1� <br /> DZ. RECEIVED COLD&INTACT I YES ) NO( , <br /> DAIEtTME DATFITWE <br /> RELIDIQUISF♦ET7BY: Rr4MWEDBY: AIR BUBBLES INV.OA.S !YES j NO L] <br /> I (SXMTURE) r CUSTODY SEALS INTACT' I YES ) NO ( ) WA i 1 <br /> A DATE/TafE <br /> REL.INQ(1MM BY.- RECEIVED BY: PRISERVATTVHS USED / YES NO <br /> r (SMA7VRE} t VAT S: Z� <br /> NOTE: PLEASE ARCHIVE THE SAMPLES SUBMITTED FOR THE KA-L HOLDING_11ME ALLOWED,UNLESS OTHER ARRANGEMENTS ARE MADE. (M.T.B.E.,T.A.M.E.,E.T.B.E.,Dl-P-13-T.B.A.) <br /> B.B.=BAILER BLANKS COLLECTED IN THE FIELD. F.B.=FIELD BLANKS COLLECT}IN THE FIELD- <br /> PINK-FIELD COPY WRITE 14 YELLOW-TO LAB.WETH SAMPLES YELLOW-RETURN TO CLIENT VYITH RESULTS, DEL-TECI1 C.O.C.FORM 98 <br />