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Client Fli'n NI L I ' fit, � <br /> EL-TECH SAMPLE CHAIN OF CUSTODY RECORD Address � 4 I f—PU-1 r �� <br /> Geotechnical Support Services (please print) Phone No. <br /> Proj. MgrXontecl <br /> 10624 Olive Avenue RECEIVED UC' 1 <br /> Oakdale Calif 95361 W3 Pink Field Copy <br /> White and Yellow To Laboratory with Samples <br /> (209)847-8757 Record of Yellow Return to Client <br /> PROJECTISITE NAME � ANALYSIS REQUESTED <br /> PR OJECTICONTRACTIPO NO <br /> NAME OF SAMPLR REMARKSISPECIAL INSTRUCTIONS <br /> LAB USE ONLY 1 ;• SAMPLE ' i a NUMBEROF <br /> � <br /> LAB I D } 1 D ATE TIME V Ir TAIHERS 1 <br /> es <br /> I <br /> RELINQUISHED BY SIGN DATEff1ME RECEIVED BY SIGN DATEITIME RECEIVED FOR LABORATORY <br /> BY(SIGN) DATE/TIME <br /> I RECEIVED <br /> RCOLD AND INTACT OTHER PRESERVATIVE'qYES ONO <br /> t <br /> ❑OTHER <br /> TURN AROUND TIME <br /> SNIPPED VIA ❑FED X CUPS OTHER SHIPPING ORDER NO 024 Hr 02 Day 05 Day �t0 Day <br />