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SAMPLE CHAIN OF CUSTODY RECORD <br /> DEL-TECH GEOTECHNICAL SUPPORT (PLEASE PRINT) Lab. Analysis by . <br /> 10624 OLIVE AVE OAKDALE, CALIFORNIA 9536/ <br /> LAB INVOICE TO t� <br /> OFFICE (209) 847-8757 >; <br /> FAX (209) 847-7744 RECORD OF <br /> PH # <br /> CLIENT / CONSULTANT: ti' P.O #I INVOICE# <br /> ���7/{�f ANALYSIS REQUESTED SITE SAMPLE MAP <br /> AFM/ '� <br /> MT TUE[AIFI <br /> PROJECT 1 SITE NAME �1�1 �Y������� {ITEMIZED ANY)CHECKED BELOR' I J (NORTH) <br /> C10 1 1 <br /> U to <br /> x Y <br /> � o m C,3 ¢ ¢ r <br /> STREET 1� p CITY �'� STATE �fi C o 11aw - <br /> �M LU <br /> 0 0 <br /> -�_ r 11J m 03 <br /> HIP VIA �Tr �-10 w m u� a -' ¢ ` <br /> SAMPLEat {PRINTED SIGNATURE/ AYBILL N o CID0 � a Q a <br /> co a r� w r w <br /> NUMBER 7Bt <br /> lyp U a xli x o 0 o C-3 <br /> SAMPLE LOCATION DATE TIME OF MATRIX r �r IDENTIFICATION) MTHM4WIM HOUR I MIN CONTAINERS r m o 0 O REMARKS/* SPECIAL NSTRUCTIONS BELOW <br /> , T <br /> E� <br /> 4)1r, <br /> �) � ddb '�� � ��� !-• � <br /> 8) <br /> 9) <br /> t�n) <br /> 6 ,,,,,j i r S4MPIE INTEGAP71/CONDITION&TURN4ROUND TIME •• <br /> RECEIVED COLD&INTACT ! }ES ��NO <br /> Q SHED BY ATE/TIME <br /> ti ECEIV ED B! iS]fMTUREI f _ ATE!T1ME. PRESER}ATI}E5 USED R_ }ES �� NO <br /> / 1 <br /> CUSTOD) SEALS INTACT 1 YES 110 �r ] NIA J 1r,� <br /> AIR BUBBLFS IN V OA'S ! YES NU LINE 8 <br /> [RELINQUISHED 81 aclrN.,TUkc ATE I TIME. RECE"ED B} UKE, ATE I TIME <br /> TURK AROUND TIME CBECh UNF <br /> RELIYQLISlIFD$} E, 'IT".. <br /> ATE IAff kCER PD BI LABORATORY —TZ TL kd Mk UST TIME ATF L TIMP 1101.11tf ) 48 HONK DA} ) 10 DA} <br /> 11) <br /> NOTE LA BO TORY SAMPLE ARCHIVING WILL BE 30 DAPS FROM THE DATE SAMPLE WAS COLLECTED,UNLESS OTHER ARRAINGEMENTS ARE MADL <br /> PLEASE RE DEL-TECH'S ICE CHEST AND BLUE ICE AS SOON AS POSSIBLE THAN `,� DEL- FORM C O C <br /> pmlr - Pu-id C'nnv / White & Yellow - To Laborato with Samples / Yellow - Return to Client with Results <br />