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� L)t_ J c ' SAMPLE CHAIN CUSTODY RECORD <br /> is 0� <br /> DEL-TECH GEOTECHNICAL SUPPORT (PLEASE PRINT) Lab. Analysis by : <br /> 10624 OLIVE AVE. OAKDALE, CALIFORNIA 95361 LAB. INVOICE TO ff_* <br /> OFFICE (209) 847-8757 a4 DOC A41E. <br /> FAX (209) 847-7744 ECORD _LOF H # <br /> CLIENT / CONSULTANT: �p,� �- I�Ss�, P.O.#I INVOICE# <br /> �F_1'd L W''' "�� ANALYSIS REQUESTED SITE SAMPLE MAP <br /> PROJECT/SITE NAME +W i �n 1� X4 r . (rTEMIZED AND CHECIXD BELOW) MOT T°t"M <br /> (NORTH <br /> STREET L CITY 1 V 1 STATE � Lf) coD4 <br /> o cr 3 Z• <br /> C >� LU W 0 <br /> W LU ca <br /> _1 <br /> HIP VIA: o s z <br /> cli <br /> SAMPLER (PR[NTED s[cNATtlI[10 <br /> WAYBILL 5 o W � s F <br /> ~O 6 a lL <br /> NUMBER TYPE AIp� i cc LU Uj <br /> co r. x o D o v <br /> SAMPLE LOCATION DATE TIME <br /> (tDBNrrFrraTroN) , mAYme Both I rarN mm,u m� ) MANX Imo. F m coo CO COgREMARKS/* SPECIAL INSTRUCTIONSSTBELOW <br /> S �b 2 <br /> 3 <br /> 4) 1 Z1 D <br /> 5) 3 z <br /> 7) <br /> s} <br /> 9) <br /> I <br /> ��/p�f „S{MPIEINMGRIT)ICONDITION&TURN4"UNDTIME •t <br /> /Sfz RECEIVED COLA 6 INTACT !`` ''YES NO <br /> REI kNQSHED BY MME, ATEI TIME vcp ?ECE111D BS wseewtuRu ATE I TIME PRESERVATM ES USED •4Y1 ES <br /> CUSTODI SEALS INTACT{ I YES ( NO { A <br /> A[R BUBBLES IN V OAS I YES { NU (XIII, <br /> N <br /> QUISHED BY DAT E RECE[%ED 81 ATEI TIME <br /> 9 7 TURA AROUAD TIME CHECA 0V <br /> 1\QLISIIED 81 bR wTI�R[� ATEI TIME /`PAS _C9 t=l� I 1.4 �R}' nnxn.xa�mr��� ATI,I Ti1IF '{ HOUR } IB }TOUR { } f1A1 10 UA! <br /> NOTE LABORATORY SAMPLE ARCHIVING WILL BE 30 DAPS FROM THE DATE SANIPLE WAS COLLECTED,[ BLESS OTHER ARRAINGENIENTS 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 />