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I <br /> -- ANALYTICAL REQUEST/SAMPLE CHAIN OF CUSTODY- LAB TRACKING # _____.. ..... .......... <br /> 747-1 <br /> '- <br /> RECORD OF DATE RECIEVED ----- ................. <br /> ----------- -----.. -- � <br /> EL-TECLAB INVOICE TO <br /> ---H GEOTECHNICAL SUPPORT SERVICES °°��'^��� � <br /> 10624 OLIVE AVENUE,OAKDALE,CA 95361 I1II.}I---------- ----------------------- b?!`;i? .... <br /> OFFICE-(204)847.5757 / IJ C` <br /> FAX -(209)847-7744 PH# (-`_� ._......_...¢s..------ ONTACT --- -._--...�...-......--- ............. .......... <br /> CALIFORNIA CONTRACTORS LICENSE#6573661 CLASS"A"ENGINEERING } <br /> O # .....................I OICE#------------- P O --- .j..... <br /> LAB ANALYSIS REQUESSITE SAMPLING MAP <br /> TED <br /> CLIENT 'CONSULTANT "4 <br /> SITE NAME PROJECT IT[) a - . I kN <br /> I <br /> �1 <br /> ADDRESS CITY PqkiWmbST <br /> SAMPLER SIGNATURE <br /> O N O <br /> SHIPPED VIA <br /> WAYBILL# — t? <br /> ANALYSIS BY TURNAROUND TIME DAYS <br /> SAMPLE ID ff DATE TIME NTAINERS TYPE MATRIX I„ I�Ilgl Ili Irl Ir``'' ai ,I,' IIl 'I REMARKS/L48.ID <br /> 5) <br /> d) <br /> 7) <br /> 8) <br /> 9) <br /> 10) <br /> 11) <br /> 12) <br /> 13) <br /> 14) <br /> 15) <br /> I]A'[E lTmm <br /> RII.INQUi51gp aY RrsElven ar SAMPLE INTEGRITY I CONDITION <br /> AN 4 N �rt i_J `Y <br /> �✓ [Su]NATURE) I D�^ RECEIVED COLD&INTACT ! YB NO [ <br /> A ! E VA'I91TNb <br /> REL.INQlllsllt�D a7 f J moo RECEIVED BY f4. AIR BUBBLES INV O A'S / YES NO / LINRS)C <br /> r ( (1 , 1 �a <br /> jt�e (s1oNA1uRE) CUSTODY SEALS INTACT I YES[ NO{ NIA ) <br /> A ! E DATE ITIME Rt:["INQCrISHEDst ke�Iv�nat` PRBSERVATIVESUSED / YES NO <br /> ! (SiCNATUPh) V <br /> NOTE PLEASE ARCHIVE THE SAMPLES SUBMITTED FOR THE FULL HOLDING TIMB ALLOWED UNLESS OTILER ARRANGEMENTS ARE MADE (M TZ E.T A M E,E T B.E,D I.P.E.,T BA) <br /> B B =BAILER BLANKS COLLECTED IN TIIC FIELD F B =FIELD BLANKS COLLECFED IN THE FIELD <br /> PINK FIELD VOP! WHITE&1 FI 1 til{ TO 1 Alt 511TH SAMPI FS 1 Ft I rnt RFTTJRN TO f f IF.NT H ITII RFSUi TS nFl! 'rami r n r srmxr nx <br /> { <br />