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-- ANALYTICAL REQUEST/SAMPLE CHAIN OF CUSTODY— LAB.TRACKING #- ----------------------•----- <br /> RECORDOF �1 DATE RECIEVED: . -.--=�--`� f------ <br /> Y - Ise-t-�ll.�C.l`---i.l h' �iY�---------------------------- <br /> DEL-TECH GEOTECHNICAL SUPPORT SERVICES LAB.INVOICE TO: <br /> 10624 OLIVE AVENUE,OAKDALE,CA.95361 y -------------------------------------------••-••-•------.----.-----------.--------------------------------------------------- <br /> OFFICE-(209)847-8757 <br /> FAX -(209)847.7744 PK.# (-•••-••-••-•)--------------------CONTACT: ................................................................. <br /> CALIFORNIA CONTRACTORS LICENSE#6573661 CLASS"A"ENGINEERING <br /> OB k ---------------------INVOICE!k - - - - -P.O.# •-------------------------------•-------- <br /> !I '._. . LAB.ANALYSIS REQUESTED SITE SAMPLING MAP <br /> CLIF,IVT: _ CONSULTANT X_7010a 4 ,v (MI <br /> SITE NAME: IM <br /> PROJECT: �{� r <br /> ADDRESS: CITY: Y ST.: O � f T <br /> SAMPLER SIGNATURE: ! rn a 1 <br /> SKIPPED VIA: WAYBILL#: <br /> ANALYSIS BY: 1 iJ u TURNAROUND TIME: . TDAYS <br /> SAMPLE I.D.I DATE TIME CONTAINERS TYPE MATRIX REMARKS I LAB.I.D. <br /> [6)l <br /> ' D � E <br /> t� �� <br /> 14 11 <br /> ) 3 <br /> 7.) <br /> L) L 1 <br /> 12.) <br /> 1�a' <br /> It <br /> ! �X <br /> 14.) <br /> [5)6 <br /> C7 - <br /> RF1.INW[SHED BY: t .' RECEIVED BY: f; � /] i A S TY SAMPLE INTEGRII CONDITION <br /> 1 <br /> (MMATURf) RECEIVED COLD t¢INTACT 1 YES I NO ( 1 <br /> .�7 ✓ / DA ITMe <br /> LRF-:L9lN4QWUfSHED BY: e i % 1 /( RECEIVED BY: - <br /> ;% :HPEOFPRESFRVATlVEfS'++r_"-_ <br /> B(BURBLES]N V.O.A.'S 1 YES NO <br /> P' <br /> (SICNATUI17 f/ C f i` �- '� �C =G'J USTODY SEALS INTACT ! YES f I O f 1 NIA f ) <br /> DATEITUdERELIN4XISHED BY: nfcE[vEp Br: ESERVATNES USED ! ti'ES NO! (SKINATURE) <br /> NOTE: PLEASE ARCHIVE THE SAMPLES SUBMITTED FOR THE FULL HOLDING TIME ALLOWED,UNLESS OTHER ARRANGEMENTS ARE MADE. * (M.T.B.E..T.A.M.E.,E.T.B.E.,D.I.P.E..T.B.A.) <br /> B.B.=BAILER BLANKS COLLECTED IN THE MELD, F.B.=FIELD BLANKS COLLECTED IN THE FIELD. <br /> PINK-FIELD COPY WHITE&YELLOW-TO LAB.WITH SAMPLES YELLOW-RETURN TO CLIENT WITH RESULTS <br /> DEL•TECfI C.O.C.FORM 99 <br />