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ANALYTICAL REQUEST/SAMPLE CHAIN OF CUSTODY LAB.TRACKING #: --------------------------- <br /> RECORD OF DATE RECIEVED-- ---------------------------------- <br /> LAB,INVOICE TO: --------- <br /> DEL-TECH GEOTECHNICAL SUPPORT SERVICES .. .. ... . ........................... -------------..............•----------- <br /> 10624 OLIVE AVENUE,OAKDALE,CA.95361 <br /> OFFICE-(209)847-8757 <br /> FAX -(209)947-77" 1 PH1 (............)--------------------CONTACT: --------------------------------------............................ <br /> CALEFORNIA CONTRACTORS LICENSE#657366!CLASS"A ENGINEERING JOB# ---------—-----• INVOICE#--------------------------P.O.# ............................ <br /> ............ <br /> LAB.ANALYSIS MQUESTED SITE SAMPLING MAP <br /> CLIENT: CONSULTANT: <br /> L <br /> SITE NAME. PROJECT <br /> I <br /> ADDRESST <br /> < <br /> S <br /> crry. --.: 777, <br /> SAMPLER SIGNATURE: ;j i s <br /> C. c� <br /> L� <br /> ISHIPPED VIA: g A <br /> WAYBELI-4: <br /> ANALYSISBY: <br /> TURNAROUND TIME DAY(S) w I <br /> SAMPLEID.0 DA TE TIME CONTAINERS TYPE MATRIX RE /LAB.LD.4 , " .1 � <br /> if '.A , <br /> i <br /> 2.) <br /> 3.) <br /> 6.) <br /> :4 <br /> A <br /> % <br /> 22.) <br /> 13.) <br /> 14.) <br /> RELINQUISHED BY: E�A RUMP'TI)BY: DATEfTDAE <br /> SAMPLE INTEGRITY ICONDITION <br /> IN, <br /> a (SIGNATURE) RECEIVED COLD k INTACT / ITS <br /> DAlb/limp TD'A No <br /> RIFLIINQUIS11M BY: A 0rDdE <br /> REMP/Eb BY: <br /> AIR BUBBLES IN V-()-A'S I YES <br /> i NO(I LINE(s)0- <br /> (SIGNATURE) SEALS INTACT I YES No NIA <br /> CUSTODY SE <br /> wm;m%N DATE I 7111AE kECEIVED BY: DATEIMME <br /> PRESERVATIVES USED / YES f, NO <br /> TIRE) <br /> 1XLE =ERV <br /> NOTE PLEASE.A.RCHIVE THE SAMPI-ES SUBMITTED FOR THE FULL HOLDING TIME A110WED,UNLESS OTHER ARRANGEMENTS ARE MADE. (M.T.B.E..TA.M.F.,E.T.B.E..D.1.1`1—T.B.A.) <br /> B-B.=BAILFR BLANKS COLLECTED IN THFHFd,D. F.B.=FLELD BLANKS COLLEC70)IN THE FIELD. <br /> PINK-FIELD COPY WHITE&VFLLOW-70 LAB.WITH SAMPLES YELLOW-RL-rURNT0('I-1E%TKITH RESULTS <br /> DEI:TECI I C.O.C.FOR%j 98 <br />