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-- ANALYTICAL REQUEST I SAMPCHAIN OF CUSTODY— LAB TRACKING #
<br /> RECORD OF DATE RECIEVED ' -° ----
<br /> DEL—TECH GEOTECHNICAL SUPPORT SERVICES LAB INVOICE TO -- T ____ i —----_
<br /> 10624 DLIVE AVENUE,OAKDALE,CA 95361 --- All,
<br /> FAX -((209)847-7744 PUN --)----------------CONTACT
<br /> CALIFORNIA CONTRACTORS LICENSE#6573661 CLASS"A' ENGINEERING
<br /> OB# --- ----INVOICE#--...---.------------------P O # -
<br /> #fl'113 II ij#ff'r!E"I „ ,,,'IIIIIIIIIEEIIi �I k ', ,I,h ,a f,EE,l,nlrf ll'i(III IIIE"I31'h,`I€I' 'i,III I Ih l f,"II II II,hh'gll'In'IIII IHElI,ifElf'fr i li !fl' I ,lllh l I,I ihil II
<br /> LAB ANALYSIS REQUESTED
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<br /> CLIENT CONSULTANT �� w m
<br /> SITE NAME PROJECT_12 I yV ►1l d
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<br /> ADDRESS IqLg CITY n E Qqt— ST M
<br /> SAMPLER S3GNATURE 1—1 T O �, m r1I
<br /> Sfi1PPF•D VIA WAYBD.L#
<br /> r2)
<br /> NALYSIS BY TURNAROUND TDAE DAY(S):
<br /> AY a�Il W
<br /> SAMPLE IX f DATE TIME CONTAINERS TYPE MATRIX ����� E�II�I�� ���I���l ffll���'IIiI�Iili��� i�Ef€ISI Ifk�ii{ illillll �iilREMARKS/LAB ID
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<br /> RELIaQUMIED BY A IJO RTICE1VED Bi .�/ �lj /p SAMPLE INTEGRITY//CONDITION
<br /> r r Q (slumn4m �f` -5 Q4 R>('1VEI)MLD&INTACT J Yds NO i �
<br /> DATEITUft
<br /> RELINQUMM B1 ` a RE ENED B5 lTR BUBBLES IN V O AS I YES NO LAf
<br /> CUSTODY SEALS INTACT+1 YES ) NO[ )
<br /> A ATE iA4E
<br /> RLINQUWMBI RECEIVED BS PRESERVATTVESUSED I 1E5 NO
<br /> 1 (S10NATURE) 1ITtPEOPPRESERVATIVE(S)
<br /> NOTE PLEASE ARCHIVE THE SAMPLES SUBMITTED FOR THE FULL HOLDING TIME ALLOWED UNLESS OTHER ARRANGEMENTS ARE MADE (MTBE TAME E T B E,D I.P.E.,T B.A)
<br /> B B =BAILER BLANKS COLLECTED IN THE FIELD F B =FIELD BLANKS COLLECTED IN THE FIELD
<br /> PINK FIELD COPi WHITE&S ELL0% TO LAB WITH SAMPLES 1 ELLOW RETURN TO CLIENT K ITH RESULTS — DEL TECH C 0 C FORM 99
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