Laserfiche WebLink
v(,o ` <br /> SAMPLE CHAIN OF CUSTODY RECORD <br /> DEL-TECH GEOTECHNICAL SUPPORT (PL8ASF PRINT) Lab. Analysis by : ,k <br /> 10624 OLIVE AVE. OAKDALE, CALIFORNIA 95361 LAB. INVOICE TO <br /> OFFICE (209) 847-8757 <br /> FAX (209) 847-7744 RECORD I OF PH. # (>%I ) RrlS�] <br /> CLIENT / CONSULTANT: QA'`-1 f)) �kT P.O. #/INVOICE# <br /> j1 ANALYSIS REQUESTED SITE SAMPLE MAP <br /> PROIECI/SIT �E NANIE: AfJM) t)n\ 1 (ITEMIZED AND CHECKED BELOW) wmwsuu, INORIII <br /> 5LA ° �-� <br /> sTREF;I': \ >n crrY: ry)Url llv lsl n� STATE: ) , !) ❑ � <br /> SIGNATURE) <br /> 'HIP VIA: � � <br /> SAMPLE ./e mreD SlcvArlmE) N'AYBILLri <br /> / 1 <br /> SAMPLE LOCATION DACE 1'I;1fE .NUMBER TI'rl' s-A WILE � <br /> I IDENTIFICA TIO,V� d/IIIJIM /]'8. DO(R/9l1,A OF ORIR OR IL17RlX <br /> (OvT11\ERs (ODVOSITF. RF.d1ARKS/* SPECIAL INSTRUCTIONS RIiLOLY <br /> - lr - 5 , 131-1 1 �LKI I <br /> D_ %I '► 1 Z 1 rib)L <br /> 3.) Ll✓ 9� 14D 2 Sb11.. <br /> 4.) <br /> 5.) <br /> 6.) <br /> 7.) <br /> J <br /> 9.) <br /> 10.) <br /> EATE400 <br /> (OVDII'12VEfCRNORO[VOTht/E/oe? RECEI\ED COLD&INTACT I IRS NO ( <br /> EL! L HEDBV:ox r ATE/TIME: EC DBY:avx\rvvc TIME PRESERVATIVES USED I YESNO�1L1 /']/ / tom \ c CUSTODY SEALS INTACT I YES ( ) NO ( N/A (/ <br /> E UISH® 9. ATE/TIME 0 E 18 Tl. y( V1 AIR BU86LES IN V.O.A.'S / YES ( NO (I�LINE N <br /> TURN AROUND TIME: CHECK ONE <br /> ATE Me: EC IV /rIBO TOR TLME: T+.uucR ( 9s.nurR ( - 1%A ( in-DA) <br /> LABORATORY SAMPLE ARCHIVING WILL BE 36 DAYS FROM THE DATE SAMPLE WAS COLLECTED,UNLESS OTHER ARRAINGEV F'.NI S ARE MADE. <br /> PLEASE RETURN DEI.TECH'S ICE CHEST AND BLUE ICE AS S(K)N AS POSSIBLE. THANK YOU DFL-TECH FORM C.O.C. <br /> Pink -Field Copy / White & Yellow - To Laboratory with Samples / Yellow - Return to Client with Results <br />