Laserfiche WebLink
=- ANALYTICAL REQUEST/SAMPLE CHAIN OF CUSTODY-_ <br /> RECORD OF A DATE RELIEVED: <br /> LAB.INVOICE TO: -- - ---�='=�..................."+---w................---------------------------•--- <br /> or I <br /> DEL—TECH GEOTECHNICAL SUPPORT SERVICES ' <br /> 10624 OLIVE AVENUE,OAKDALE,CA.95361 -- -_--.-R. ---- -�- �-~- - ----- ---- ---•.........................--------— <br /> OFFICE-(209)847-8757 <br /> M -(209)847-7744 PILOPck.-5_2; .CONTACT: ................ ...:..._._......---------- <br /> ---------------------INVOI <br /> CALIFORNIA CONTRACTORS LICENSE#6573661 CLASS"A"ENGINEERING ,. <br /> OB# <br /> LAB.ANALYSIS REQUESTED SITE SAMPLING MAP <br /> .��I, <br /> „I, J.:III•,,. <br /> CLIENT: b y` *.f/ CONSULTANT: cc <br /> (r�osTep <br /> SITE NAME: C PROJECT: n <br /> ADDRESS; W. �* CITY: ST.: tif� a <br /> O C� ai h s» <br /> SAMPLER SIGNATURE: <br /> SHIPPED VIA: WAYBILL It: <br /> ANALYSIS B TURNAROUND TIME: DAX S F• F W w �o <br /> Ikl'E SAMPLRID.I DATE TIME CONTAINERS TYPE MATRIX i'� i,i , ;�,i II '1 li' ;'• 'I l' i 1� <br /> !� -, . ; I i ,�`, .I � .Ii."i !I ! � ! REMARKS/LAB.I.D. <br /> 2.) � . <br /> 3.) <br /> 4.) -.. <br /> 5) <br /> 7.) I <br /> Q a <br /> s.) <br /> 9.) <br /> 10) <br /> 12.) <br /> 13.) <br /> 14.) <br /> I5.) <br /> r RELg2VFED B7; <br /> RELINQUM EDGY: ," SAMPLE INT GRIT)I CONDITION <br /> _ i�3 ; <br /> i <br /> I!r'r (SKWATURE) � t .2 RECEIVED COLD&INTACT !YES f NO <br /> RELINQSJ151-)ID By; ,Ar dJ t REAR- mBt': AIR BUBBLES IN V.U.A.'S ! YES NO iN S A- <br /> �""f! b 911NATURI I t I r• / i [ E'` W/ ?LJ CUSTODY SEALS INTACT !YES NO( NIA f ) <br /> F/J "UA7 DATE'_ <br /> RMII+IQIIS11 D Bp; RLCEIVBD BY; PRESERVATIVES USED / Y O <br /> r (SKMATUM V <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 FIELD. F.B.=FIE.D BLANKS COLLECTED IN THE FIELD. <br /> PINK-FIELD COPY WHITE R YELLOW-To LAB.WITH SAMPLES YELLOW-RETURN TO CLIENT WITH RESULTS DEL7ECH C.O.C.PORNI 98 <br />