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v� 4 �� <br /> -- ANALYTICAL REQUEST/SAMPLE CHAIN OF CUSTODY LAB-TRACKING It: ------- -�--- <br /> RECORD J OF <br /> DATE RECIEVED: --------_.__..--------------- <br /> LAB.INVOICE TO: .._ t.- -.-... _��_ _ _... <br /> EEL-TECH GEOTECHNICAL SUPPORT SERVICES <br /> VW <br /> �j �yy� <br /> 10624 OLIVE AVENUE,OAKDALE,CA.95361 ---- _]. --..-I _. s._ I—. L _� � +�1_ '_--953 �------- <br /> OFFICE-(209)847-8757 s <br /> T----- ------ <br /> FAX -(209)847-7744 PH.# L1 1CONTACT: Eg—ilt ._-•.--------------------------------------- <br /> CALIFORNIA CONTRACTORS LICENSE#6573661 CLASS"A"ENGINEERING <br /> LAB ANALYSIS REQUESTER SITE SAMPLING MAP <br /> CLIENT: CONSULTANT: ' ' �] s (MRTM <br /> SITE NAME: PROJECT: JVA s 1 PST.- <br /> !(+�I ADDRESS: t � C1TY x CD sri a( <br /> SAMMER SIGNATURE• 1w <br /> SHIPPED VIA: WAYBILL#: <br /> dppi.. x pdp.,, c g ' <br /> ANALYSISBY: TURNAROUNDTIIVIE: <br /> DAY(S) E+ W i0.�1 a`Vc <br /> Iiilj SAMPLE L.D.# DATE TIME CONTAINERS 7YPE MATRIX �il a , ;II j li , ';' ' j,' iii ','!,i 'n�I {" REMARKS/GAB.LD. <br /> 1.) 1 <br /> 3.) r. $s <br /> 4.). <br /> 6.) F�, $„e <br /> z.) It ei a <br /> s.) <br /> 9.) <br /> 12.) <br /> 13.) <br /> i <br /> 14.) <br /> I5_) <br /> RELINQUIFD BY. RF.CENED BY: - �•'•} DATE 1�4r15 <br /> ISE <br /> f ;cf S MPLE IN &GRITY/CONDITION <br /> J (SIONATUW '^ '/ � i'/ RECEIVED COLD&INTACT ! YES,Loff NO { ) <br /> RII.trQQ[l1S1frDBY: /' l / ;r3 RSLTi[Vm BY: // ,.r'` D, AIR BUBBLES EN V.O.A.'S / YES 1 NO LIN5 A- <br /> (SA7NA7UR5} CUSTODY SEALS INTACT I YES NO( ) NIA f ) <br /> DAREI,INQ[715fFp 11Y: JL <br /> RTfF1V[:'p B5': PRESERry <br /> VATES USED J YES NO <br /> ama — =�i I1 (SIGNATURE) <br /> NOTE: PLEASE ARCHIVE THE SAMPLES SUBMITTED FOR THE FULL BOLDING TIME ALLOWED,UNLESS OTHER ARRANGEMENTS ARE MADE. � (M.T.B.E.,T.A.M.E.,E.T.B-E.,D.I.P.E.,T.BA.) <br /> B.B.=BAILER BLANKS COLLECTED IN THE FIELD. F-B.=FIELD BLANKS COLLECTED IN THE FIELD. <br /> PINK-FIELD COPY WHITE&YELLOW-TO LAIL WITH SAMPLES YELLOW-RETURN TO CLIENT WITH RESULTS DF.T.•TFA H r.O.C.FORM 98 <br />