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- <br /> SAMPLE CHAIN OF CUSTODY RECORD (1- 4- &34), <br /> DEL-TECH GEOTECHNICAL SUPPORT (PLEASE PRINT) Lab. Analysis by <br /> 10624 OLIVE AVE. OAKDALE, CALIFORNIA 95361 LAB. INVOICE TO : WI,-�'ECA <br /> OFFICE(209) 547-8757 <br /> FAX (209)847-7744 RECORD _3_OF PH.# <br /> CLIENT/ CONSULTANT: 2,In Ali,%- P.O.#I INVOICE# <br /> I ND QAAAf-Tm <br /> ANALYSIS REQUESTED W EgeR SITE SAMPLE MAP <br /> PROJECT/SITE NAME: 1 1 .1? r IMMIZED AND CEEC ED BELOW) " s" n <br /> (NORTH) <br /> c <br /> U 8 � <br /> STREET: 51 L&152--T �' <br /> CITY: rbZJV1TD�J STATE Qam co ry <br /> cc STATz q <br /> g Q Q O <br /> 5 <br /> p <br /> _( Ov U O H W m <br /> HIP VIA: g -j o m m � 4 <br /> Uj <br /> SAMPLER:mRmw SICNALum AYBILL� 4� o CD <br /> 0C,cc <br /> SAMPLE LOCATION DATE TIME NUMBER TYPE SAMPLE 8-W x o 0 o Ca <br /> (MENTIfICATION) MMAVAYPIM 80UR/MIN. OF {CRAB OR MATRIX a cr° o cv N F <br /> L10NTAINERs OO,Yl,OSITE) 1— 1— CO co co .ao REMARKS/ SPECIAL INSTRUCTIONS BELOW <br /> I) !a RSB <br /> H1, 9 Lam- g Y11t, <br /> 2.) t'Y-A A Dlily —1- <br /> 3.) rYuAp- <br /> 4-) tY111N <br /> 5.)yYv-Aj 13 am <br /> 6.) \(v�I IZ <br /> -7., ,,� - &B 3 l l <br /> 9.) two 396 11LIC, <br /> ".UAfFIEINIEGRlf1/COMMON&TURNAROUND TIME �+ <br /> RECEIVED COLD&INTACT / YFS NO � } <br /> REL Q DATEI TIME EIVED BY>mGr rL*Z, DATEI TIM O?xPRESERVATIVES USED WO-Y&S ;4 NO <br /> CUSTODY sEALs INTACT I Y&c NO { } WA <br /> /+jam' AIR BUBBLE9 IN V.O.A-'S I YES } NO/ LINE I <br /> H ATE I TIME: ` EEV ED BY:a�eeurvxp ATE I TIME_/ <br /> TURN ARtlUND TIME. CHECK 011 <br /> ' �•\SIX fr G <br /> p7� 24.YOUR 49.HOUR S•DA)' 10-DAY i } <br /> l.TSNQI BY:ax=Mn�ec,� ATE!TIASF ECEry v BY tABORArohY_,�r«�,��.,,,„�, ATE 1 TIME- <br /> NOTE--LABORATORY SAMPLE ARCHIVING WILL BE 30 DAPS FROM THE DATE SAMPLE WAS COLLECTED,UNLESS-OTHER ARRAINGE'_NENTS 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 /> i Pink- Field Copy . 1 White &Yellow -To Laboratory with Samples 1 Yellow - Return to Client with Results <br />