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-- ANALYTICAL REQUEST/SAMPLE CHAIN OF CUSTODY-- LAB.TRACKING #: ------------------------••-- <br /> 0 RECORD —L OF DATE RECIEVED <br /> ZzLav � - -r '...IC I- ------------------- <br /> TECHNICAL SUI <br /> 10624 OLIVE AVENUE,OAIDALF.,CA.95365 --^ ------- - -- ..... ._- <br /> OFFICE-(209)847-8757 9907000434- FRONTIER-TRA , <br /> -..... CO1rTACT. -------__....-- ......................... .... <br /> FAX -(209)847-7744 <br /> CALIFORNIA CONTRACTORS LICENSE 4 657366/C :,; I <br /> ,- _. - ------------------ <br /> -------- <br /> - --.... <br /> .,. <br /> INVOICE M <br /> rSIS REQIIFBTFD SITE SAMPLING MAP <br /> (NOkTkf ' 1,, <br /> CLIENT: CONSULTANT: <br /> SITE NAME: ,5APROJECT: >; <br /> ADDRESS• L CITY: ST•' + F <br /> SAMPLER SIGNATURE: t O <br /> SHIPPED VIA: fid- WAYBILL : x e F <br /> ANALYSIS BY: BS 1L TURNAROUND TIME: DAYS w a`vo w w <br /> SAMPLE I.A.* DATE TIME CONTAINERS TYPE MATRIX REMARKS/LAB.I.D. <br /> q 3 4 i Zo $ <br /> 6 zo <br /> u - 2 -z o 8 . <br /> ) f vw -2-o v <br /> N <br /> r ( I rZ eS ' ' Lam{ E TV 1,Pf p. j <br /> amu - <br /> f a � o $ R. <br /> a VrvA)— <br /> 16 <br /> i L <br /> 1 S <br /> A(j`/ RFLEfVE:D RY. �yDA ply A SAMPLE INTEGRITY I CONDITION <br /> REt,WW3S}MB!' V f tT f G"I7 / <br /> rI (mNATURE) RECEIVED COLD&iNTACr I YES f i No I 1 <br /> DALE I TrAE <br /> Rft.LNQDlSHED RY. � - /C��9 REC'1:IVED eY: AQ(E;UBBLES IN Y,O.A:S J YES I y0Z, L[VFIS M <br /> LL <br /> l,.NATVREI + 3 CUSTODY SE ALSINfACI' I YES ( NO : I N!A ! I I <br /> fi1_LL^1QL'ES MBY A RECEIVFDBY r /Jjfjf, E PRESERVATIVES USED J YES NO ( 3 <br /> y � (SIGNAniREISIGREi <br /> i <br /> NOTE ri-FA .91\'E T14F SAN1PE 1:S St'8.�1f1-TFE}FoR'rIIF.FILE.IIOI.IIINL:T11IE AI1.()ATIt,1;ti1-F'SS nZ'IIR ARR!' 'MFNTI AlI \1.AI)E: 4' (M.T.B.F...T.A.M.E.,E.T.B.E.,11.I T.B.A.) <br /> B.B.=BA WLANKS('[1.1.1--('1 E-D IN I .}11.1 . 17.13.=FIELD BLANKS('OLLL:C-fk E)E. <br /> rw v �<<nr4 inf WITiw Fs "ba, <br /> RET I'E.IE I RES <br />