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SAMPLE CHAIN OF CUSTODY RECORD <br /> DSL-TECH GEOTECHNICAL SUPPORT (PLEASE PRINT) Lab. Analysis by <br /> 10624 OLIVE AVE. OAKDALE, CALIFORNIA 95361 LAB. INVOICE TO : OEL.Tt<A <br /> OFFICE(209) 847-8757 <br /> FAX (209)847-7744 RECORD OF 2— PH.# (meq ) 7$15-7 <br /> CLIENT/ CONSULTANT: WEI, MVT'TE C_ftVyN MLL P.O.# INVOICE# <br /> ANALYSIS REQUESTED SITE SAMPLE MAP <br /> PROJECT/SITE NAME: 1T W 4 WvFn 110-IN1V (BEMIZED AND CHECKED BELOW) °V T"GCAM <br /> (NO <br /> c <br /> - T <br /> Q <br /> . ,�. v � Z oYc <br /> STREET: ��L } CITY: ��1 ybA 'STATE: Uj g oCD <br /> o ua o� w o o w <br /> SAMPLER:(rRwm sICNATuM AY$iLl,# co <br /> o C ¢ Q <br /> OQ d <br /> SAMPLE LOCATION DATE TIME NUhIBER TYPE SAMPLE .s z x o 0 o v <br /> s lARNL1F7CA?NON) llffB'1DAYM1. HOUR!A[IN. OF (GRAB OR MATRIX d IZ � o N N <br /> ( _jmxnu,�ss aoM►rosnx) F- m CO CO CO REMARKS/ SPECIAL INSTRUCTIONS BELOW <br /> : I � - z s�gL j 1 V <br /> R <br /> 3•) t1 <br /> t 4.) tyvls <br /> s.) <br /> 7) kahs, ca Itob <br /> 8.) <br /> 1 .. "StiMPI!'►NTEGRII'Y/C70NDI370N d TURNAROUND TIME <br /> RECEIVED(pyo-INTACT <br /> ! YES Y NO <br /> t <br /> I ` , k[ISggf. m,BATE!TIME:D RECEIVED BY:s�cnaruut, ATE I TIMES& PRESERVATIVES USED�V YES NO <br /> 0 J//J} CUSTODY SEALS INTACT I YE.S NO ( } NA <br /> . \ P► 06 ����� , NO LINE f <br /> _ AIR BURBLES IN V.OA.'S YFS <br /> ATE 1 TIME: 61VEA BY:0sicru7vxe, ATE I TIM. <br /> 9 TURN AROUND TIME: CHECK ONE <br /> / INQC35HED BS':eKrwnxn AVE I TIME:/7 ECEI t�FU E}�LABORATa =�. mKn.kourn n-�� ATE I TIME: •iIUUR ' 48•IiOUR { ' :•DAI IO•DAY <br /> NOTE:'QLABORATORY SAMPLE ARCHIVING WILL BE 30 DAYS FROM THE DATE SAMPLE WAS COLLECTED,UNLESS OTHER ARRAINGEMENIS ARE MADE. I <br /> PLEASE RETURN DEL-TECH'S ICE CHEST AND BLUE ICE AS SOON AS POSSIBLE. THANK YOU DEL-TECH FORM C.O.C. <br /> s"" Pink- Field Copy 1 :White& Yellow-To Laboratory with Samples / Yellow - Return to Client with Results <br />