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Client wD <br /> �L-TECH0 <br /> SAMPLE CHAIN OF CUSTODY RECORD Address c , b_Geotechnical Support Services (please print) Phone No. <br /> 10624 Olive Avenue Pro!. MgrJContat:t _ C4.- <br /> Oakdale Calif. 95361 Pink-Field Copy <br /> (209)847-8757Record___�_of White and Yellow-To Laboratory with Samples <br /> Yellow•Return to Client <br /> PROJECTISITE NAME: ¢art ?lrQANALYSIS REOUESTED <br /> Ls t,+ )40 1 e <br /> PROJECTICONTRACTIPO NO.: <br /> NAME OF SV REMARKSISPECIAL INSTRUCTIONS <br /> LAB USE Oe SADE � a NUMMF ER <br /> LAB I.D. DATE TIME 0 <br /> o 0 ITAINERCON- <br /> S <br /> !\® C <br /> Ix\s <br /> i <br /> RE INQUISHED BY SIGN ATEIfIME RECEIVED BY SIGN DATEITIMF RECEIVED FOR LABORATORY <br /> 6 aA D�mpI�/la�Y3 <br /> 14" /dd/J BY(SIGN): DATE/TIME <br /> RECEIVED: <br /> D40LD AND INTACT OTHER PRESERVATIVE ,;YES ONO <br /> MT II L o <br /> CQA�DaTURN AROUND TIME:=M �' o <br /> SHIPPED VIA: OFED X ❑UPS OOTHER: SHIPPING ORDER NO.: 024-Hr 02-Day 05-Day �*O-Day <br />