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Client 5{4'` <br /> DEL-TECH SAMPLE CHAIN OF CUSTODY RECORD Address D A'Umb , <br /> Geotechnical Support Services (please print) Phone No. 6 3 <br /> Proj. MgrJContact mak£ FLn;E, <br /> 10624 Olive Avenue <br /> Oakdale Calif. 95361 Pink•field Copy <br /> 209 847-8757 ' White and Yellow•To Laboratory with Samples <br /> ( l Record of_ Yellow•Return to Client <br /> glvssr/�,i <br /> PROJECTISITE NAME: p A 1b�5 W, t� �', ANALYSIS REQUESTED <br /> PR JECTICONTRACTIPO NO.: <br /> L i <br /> NAME OF SAM ER: r . 4 - V REMARKSISPECIAL INSTRUCTIONS <br /> LAB USE ONLY SAMP o: m NUMBER , Q � O C <br /> LAB I.D. I.D. DATE TIME O ¢ CON- V L <br /> O TAINERS <br /> 30031 ; K "A07N 1100 1 <br /> 116110 .-. N INas X <br /> = D1 <br /> Nis- L, r. it <br /> - <br /> 3n037 <br /> ml Ll <br /> I I+ <br /> RELINQUISHED BY SIGN D TEITIME RECEIVED BY SIGN DATErnME RECEIVED FOR LABORATORY <br /> wok �19 t,7"- Z. ;.:3 F3 - BY(SIGNI: DATErnmE 'v'T-P <br /> - <br /> RECEIVED: <br /> AOLD AND INTACT OTHER PRESERVATIVE OYES ONO <br /> TURN AROUND TIME: <br /> SHIPPED VIA: OFED X ❑UPS OTHER: SHIPPING ORDER NO.: 021-Hr 02-Day 05-Day 9I0 Day <br />