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SAMPLE CHAIN CUSTODYV RECORD <br /> 0 <br /> � Lab. Analysis by <br /> SEL-TECH GEOTECHNICAL SUPPORT (PLEASE PRINT) y ��( <br /> 10624 OLIVE AVE. OAKDALE, CALIFORNIA 95361 LAB. I1�VOICE TO <br /> OFFICE (209) 847.8757 PH.# b <br /> FAX (209) 847-7744 RECORD �OF <br /> CLIENT / CONSULTANT: my k� P.o.# INVOICE# <br /> 1 SLI U � ANALYSIS REQUESTED ff�TSITE SAMPLE MAP <br /> .�.��p ��] {lTEMf7ED AND CHECKED$FLOW) (NORiII <br /> PROJECT 1 SITE NAME: ►�►l�.�f" Lj� �Pr <br /> u] U_ U <br /> Zt�g � Z ¢ _ <br /> �+ ,,p C�jA (�� o a m a z < § . Z <br /> STREET: t `civ vl o itl`a .Ir: ��"� STATE: `.4 � M Lu,Q � 0 6 <br /> cz Lu cc <br /> x " w 7RO f <br /> `4 o w} <br /> utt HIP VEA: _ � � ¢ a � <br /> wr WAYBILL l+ w a d m t7 <br /> SAM (rIR M ED SIGMTUM Q <br /> S2 <br /> o m a a <br /> U-1 <br /> Q u] z <br /> NUMBER TYPE <br /> SAMPLE LOCATION DATE TIME aF {cRA$oR � s = IL J <br /> � COMPOSITE 1 MATRIX a 0- °C o N N REMARKS I* SPECIAL INSTRUCTIONS BELOW <br /> (H)MMFICATION) MTHJDATIM HOUR I NTN. t--- r m m m m <br /> i.v vow <br /> 4.) 3 <br /> 5.) L <br /> 6.) <br /> �.) b <br /> � Q <br /> 8.) I 9.) <br /> !O - /� SAMPll+lNTEGRIT}'ICONDITIONATURNAROUNDTIME <br /> ry 7 R£CEIV@ COLD d INTACT ! }•gs NO <br /> ATEI rim e PRESERVATIVES USED ES NO { <br /> ISH@ ATE I TIAIE_ ECEIV ED BS':�suwinxu 1 <br /> .w vsn CUSTODY SEALS INTACT I YES NO NIA <br /> AIR BUBBLES IN V.OA.'S I YES L NII LINE✓< <br /> ATE i T KEC:EIVED BY: n�u ATE I TIME-. <br /> ISII@ B}.:awd+Tvai. TURN AROUAD TfFlE: CHECIiONE <br /> �f p ��`^'��r_ - "�� ���"" "" `"l/l.J � � '.1-FTU!?K � � 4R-}TOUR � ) _-DAl' 1 1 10-iIAS' <br /> )ATEI TI\SE:f p�O I:CF.II'���IJDATE/TIME: <br /> R :'QI:ICIiFiI B}':sk:..nv:c. _ <br /> NOTE: LABORATORY SAMPLE ARCHIVING WILL BE 30 DAPS FRO THE DATE.SAMPLE WAS COLLECTED,UNLESS OTHER ARRAI\GE 14ENTS ARE MADE DFL-TECH FORM C.Q.C. <br /> PLEASE RETURN DEL-TECH'S ICE CHEST AND BLUE ICE AS SOON AS POSSIBLE. THANK YOU <br /> Pink - Field Copy 1 White & Yellow - To Laboraton, with Sulnple.s / Yellow - RCILI n to Client with Results I <br />