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Client <br /> ML-TECH SAMPLE CHAIN OF CUSTODY RECORD Address LeK -, <br /> ' _ Geotechnical Support:Services (please print? Phone <br /> _ jProj. Mgr,lContact 1 b -LLI <br /> 10624 Olive Avenue ' <br /> Oakdale Calif. 95361 Pink-Freid copy i <br /> 209 847-8757 White and Yellow-To Laboratory with Samples <br /> Record o} Yellow•Return to Client <br /> PROJECT/SITE NAME:' y, Q ANALYSIS REQUESTED <br /> �. 01 <br /> PROJECTICONTRACTIPO NO.: , <br /> NAME OF.SAMPLER; A7 REMARKSISPECIAL INSTRUCTIONS <br /> •tAB USE ONLY- MPLE i - NUMBER <br /> a OF _ <br /> LAB I.D. - I.D. ATE TIME O x CON= <br /> U ITAINERS <br /> ... .M_�" �� - - ��� �- • •s 1. 1 -$3 Vii' '(yam l� �;. <br /> 1'�1N !73 <br /> ' + _�� ,�� � - - " - 1 • 4e .lid ba`4 „ir� <br /> Op <br /> l <br /> RELINQUISHED BY SIGN DATE/TIME• 'RECEIVED BY(SIGN) ' DATE/TIME `. RECEIVED FOR LABORATORY - <br /> (SICIV <br /> DATE <br /> 'VCOLD'AND INTACT $. `OTHER PRESERVATIVE ❑YES. O` <br /> ❑OTHER: <br /> TURNAROUND TIME: <br /> SHIPPED VIA:. l7FE0 X CUPS OTHER: SHIPPING^ORDER NO.:. <br /> 0 <br /> 24 Hr.t 02 Day' b5-Day Day'• <br />