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iaw <br /> SAMPLE CHAIN OWUSTODY RECORD <br /> DEL—TECH GEOTECHNICAL SUPPORT (PLEASE PRINT) Lab. Analysis by . J'RtgA <br /> 14624 OLIVE AVE. OAKDALE, CALIFORNIA 95361 LAB INVOICE TO (I f EL � <br /> OFFICE (209) 847-8757 <br /> FAX (209) 847-7744RECORD OF PH # <br /> CLIENT 1 CONSULTANT: ��I' 6Z:" iLt ` ' . P.O.# INVOICE# oc <br /> 01 <br /> ANALYSIS REQUESTED SITE SAMPLE MAP <br /> PROJECT/SITE NAME. YyAO-1TA6 &gss (ITEMIZED AND CBECRED BELOW) <br /> (NORTH) <br /> i <br /> Lei r <br />! O U Z LY <br /> iJ <br /> STREET w CITY- ""f-'1v STATE o Uj e o �3 <br /> W ® L <br /> oQ Uj <br /> o y <br /> L} � HIP VIA w m a x z m F t <br /> SAM SIG ATUM <br /> WAYBILL ffi w m `a' LD <br /> c <br /> J <br /> < � <br /> SAMPLE LOCATION DATE TIME NUMBER TYPE z <br /> c� o x t x o o <br /> s z as <br /> (IDBNrrFICATION) A�lgl041Y/YR SOURI#fIN Po F � m CO` � � REMARKS/ PECIAL INSTRUCTIONS BELOW <br /> I)�M tB �� Ll c_ <br /> 3} \%V%A Z <br /> S) _ �� �� <br /> 6.) �? t6 'L <br /> ?) \V Y- L 6 <br /> 8) <br /> 9) <br /> IO <br /> SAMPLE INTEGRITS/CONDITION&TURNAROUND TIME •• <br /> RECEIVED COLD&INTACT ! AFS To <br /> IN411YI BY csw' DATEITIME ECEINEDBI aicwtitntc, � DATE ITIM I— FRESEM ATIv ES USED �`�(L]FS (� NO <br /> CUSTOM SEALS INTACT / YES ( NO NIA <br /> AIR BUBBLES In%OA S I YES NO LINE# <br /> RELINQUISHED B} DATE/TIME RECEIVED ON JDATEI TIME <br /> TURK AROUND TIME CAECA ONE <br /> i[RELINQLISIIID B! aF urawc ATE/TIM ECEIYF_D BY LABORATOR1 DATF I TIMF ?.I HOUR � � 18 HOUR � � � 0A)/to AA5 <br /> NOTE LABORATORY SAMPLE ARCHIVING WILL BE 30 DAPS FROM THE DATE SAMPLE WAS COLLECTED,UNLESS OTHER ARRAINGEMENTS ARE MADE. <br /> PLEASE RETURN DEL-TECH'S ICE CHEST AND BLUE ICE AS SOON AS POSSIBLE THANK YOU DEL TECH FORM C O C <br /> Pink - Field Copy / White & Yellow - To Laboratory with Samples / Yellow - Return to Client with Results <br />