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ANALYTICAL REQUEST/SAMPLE CHAIN OF CUSTODY— LAB TRACKING s ------------ -- ------- <br /> RECORD t OF � DATERECIEVEb <br /> r�. LAB INVOICE TO - <br /> W <br /> DEL-A ECH GEOTECHNICAL SUPPORT SERVICES <br /> 10624 OLIVE AVENUE,OAKDALE,CA 95361 �--_-EY>����'" �,� $_�&#! � i�'+?�j �_.e����----���` �---- --' - --- <br /> OFFICE-(249)847-8757 <br /> FAX -(249)847-7744 PH# =: .-� CONI ACT =_ 3:° <br /> r-----" scl-_ .....m..--------- <br /> CALIFORNIA <br /> -------........ <br /> CALIFORNIA CONTRAC'T'ORS LICENSE#6573661 CLASS"A"ENGINEERING I <br /> OB# --------------- INVOICE#... <br /> I <br /> uii� 1 1 rl II i r III Ir I ill 1�l 1 nn' ' ' f11� 1 1 11 ' II lir 41�1i�Iprl I rlr 31 r II 111 Ifr I II fel I� n 111 LAB.ANALISIS REQUESTED <br /> SITE SAMPLING MAP <br /> CLIENT I `,.'�' CONSULTANT' vYn� _ °N�Oum @ <br /> pc �*' i ^r 3�'k <br /> SITE NAME . 'eel �. u PROJECT y F 1� I <br /> ADDRESS w ° CTI'Y f c ST f y.F ! O ! 7Ik3o-� <br /> x� <br /> SAMPLER SIGNATURE L <br /> k'� a 0 0 <br /> SIDPPFU VIA l WAYBILL# �` C� % � x <br /> {i7 C pdp�. d , d d �,I 3 l <br /> ANALYSIS BY klLp� TURNAROUND TIME �I �I v DAY ." c� w av w W <br /> '1 1 DATE MATRIX REMARKS I LAB I D <br /> I . SAMPLE I D TIME CONTAINERS TYPE 1"= l <br /> 1113� irl <br /> t) 7 � f <br /> 2} vat 's F <br /> r i <br /> p-1 LyD <br /> 5} �" <br /> 7) <br /> 8) <br /> 9} 1 <br /> to) d <br /> 3 <br /> Lt} <br /> 12) � <br /> 13) <br /> 34} <br /> ]5) <br /> RE1.INpU3SItED Bt b DATE IT ME <br /> w v I R�l1EDBy 1 /1 SAIN LF INTEGRITY/CONDITION <br /> (SIGNATURE) <br /> -,73efa"� �` ��•'�t�3,fi- a..- �.v° ''' 1 <br /> RECEIVED COLD A INTACT ! YES `NO <br /> RELINWISHEDBS /"',r i! /,L"'-� RECEIVED 0) PATE/TI4€E 4 <br /> 71 w A[R BUBBLES IN V O A S ! YES NO LIN S f <br /> Y <br /> (SIGNATURE) CUSTODY,�pZ��, �'� JCS ,tA£-� - � r CUSTODY SEA[S INTACT ! tES (,i") NO!r NIA 1 � <br /> I u TE 1TA1 <br /> REL6NWISI]ED B1 4� "� RECEIVED BS DATE I TNN PRESERVATIVES USED ! IESJ;; !NO <br /> ! tSiGNAWRE) I Y <br /> NOTE PLEASE ARCHIVE TILE SAMPLES SUA& TED FOR THE PULI HOLDING TIME ALLOWED UNLESS OTIW-R ARRANGEMENTS ARE MADE * (M T.B E TAME,E T B E D I P F,'TBA) <br /> B B -BAILER BLANKS COLLECTED IN 7 HE FIELD f B =FIELD BLANKS COLLECTED IN THE FIELD <br /> PINq FIPI II l nPS it t11TGF\Cl�nil TnT Ap LS T'e",l CAhiPI FC ♦irr�.i, nr-...,. mr r.�rw1+. �r nnn <br />