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Client Vf _ <br /> DEL-�d T ECH SAMPLE CHAIN OF CUSTODY RECORD Address F' cA`42 E-K <br /> Geotechnical Support Services (please print) Phone No. N'� 7 `� t� <br /> Prof. MgrdContact <br /> 10624 Olive Avenue <br /> Oakdale Calif 95361 Pink-Field Copy <br /> White and Yellow-To Laboratory with 5amplea <br /> (209)847-8757 Record, of Yellow Retem to Client <br /> PROJECTISITE NAME " ,t.., - f) � �t:e�err P-- ANALYSIS REOUESTED <br /> S,t r r��f_r, ;tee•�.�� ��` � ` I �'y.� r\iw �r <br /> PROJECTICONTRACTIPO NO <br /> NAME OF SAMPLERR REMARKSISPECIAL INSTRUCTIONS <br /> � t <br /> r <br /> LAB USE ONLY SAMPLE a m NUMBER <br /> LAB I D t D DATE TIME O ¢ CAN- T <br /> U TAINERS <br /> rl <br /> � r <br /> n ` <br /> D <br /> J <br /> RELINQUISHED BY(SIGtg DATEITIME RECEIVED BY SIGN DATEMME RECEIVED FOR LABORATORY <br /> BY(Slow DATUDME <br /> RECEIVED• <br /> ! <br /> PtOLD AND INTACT OTHER PRESERVATIVE OYES $tNO <br /> ❑OTHER: <br /> TARN AROUND TIME <br /> sRiPPEM OFED X OUPS OTHER SHIPPI RDER NO 024-Hr 02 Day 05-Day WO-Day. <br />