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-- ANALYTICAL REQUEST/SAMACHAIN OF CUSTODY-- LAB.TRACKING #: - ` --------�-- <br /> RECORD I OF 'T� DATE RECIEVED: <br /> LAB.INVOICE TO: .. 1-- =r1 ------ --_" �� <br /> DEL-TECH GEOTECHNICAL SUPPORT SERVICES <br /> 10624 OLIVE AVENUE,OAKDALE,CA.95361 <br /> OMCE-(209)8474757 <br /> FAX -0 847-7744 PH.# <br /> CALIFORNIA CONTRACTORS LICENSE#6573661 CLASS"A"ENGINEERING <br /> OB# -------INVOICE# --- -—P.O. <br /> I l[!f 1I:iil' <br /> I,.. , 1 l ,-1.111111 I li Ilil, I,I_,, ii , I I L11lY1 Illy-Ili , Il,lll-I,I f€l-i,llll �I "..:�'I,Illl.l.11ll;lil _rl I !{.�.1�Irl !.u;lkb LAS.ANALYSIS REQUESTw SITE SAMPLING MAP <br /> .I...I.,-Ifll <br /> CLIENT CONSULTANT: <br /> SITE NAME: PROJECT: p, >' <br /> ADDRESS. hmth 4A CITY: ST.: + �[ e8 Y = <br /> o ISc <br /> SAMPLER SIGNATURE: ` p c c <br /> F M A - <br /> o r"i o <br /> SHIPPED VIA: WAYBH L#: `~— x ►' d e d d E" �� <br /> �o <br /> ANALYSIS BY: TURNAROUND TIME: DAY <br /> I, 'll !'•.I'i, I 1 -'Ilii! Ifll!I I, 1 1111 ,II, 3 ;',''1 REMARKS/LAB.I-D. <br /> SAMPIEIAI DATE TIME . CONTAINERS TYPE MATRIX <br /> 1') <br /> 2) D t�-V <br /> 3) <br /> 4) <br /> Z 1 <br /> 6) 1111�7 q. Ex-01 <br /> 7) <br /> 9) <br /> 1x-) <br /> 13.) "` <br /> 154 O'U L" <br /> DATEITME <br /> A RK'ELVED BY: ' ) f SAMPLE INTEGRITY/CONDITION <br /> RII.INOULSF3FD BY: r� 9`1 .� <br /> N4� (S10NAT'Ul1E} / - r�. />.C'^ RECEIVED COLD&TNTACT I YES NO f ) <br /> A DA I TLME <br /> I RELINQUSSFg•D 6Y'. '. <br /> RFCF[VFp HY: AIR BUBBLES[N Y.O.A.'S 1 YES NO ( INF(S)N- <br /> I (SFGNA'LURE) I CUSTODY SEALS INTACT ! YES NO f ) NIA f 1 <br /> A I DATE IT'AtE <br /> RELINQUMED BY: RECEMED BY: PRESERVATIVES USED I YES NO L <br /> I (SIONAIURE) I TYPE 2P PRESERVATEMS); <br /> NOTE: PLEASE ARCHIVE THE SAMPLES SUBM=D FOR THF.PULL HOLDING TIME ALLOWED,UNLESS OT1IFR 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 COiL£CI'ED IN TFIF MFLD. F.B.=FIELD BLANKS COLLFC FED IN T[M FIELD. <br /> PINK-FIELD COPY WHITE R YELLOW-TO LAB.WITI1 SAMPLFS %'ELLOW-RETURN TO CLIENT WITII RFSULTS AF:I:TFC}I C.O.C.FORM ad <br />