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SAMPLE CHAIN OF CUSTODY RECORD <br /> DEL-TECH GEOTECHNICAL SUPPORT (PLEASE PRINT) Lab. Analysis by ; #1q.5D <br /> 10624 OLIVE AVE. OAKDALE, CALIFORNIA 95361 LAB. 'VOICE TO : Q �� <br /> OFFICE (209)847-8757 8 <br /> FAX (209)847-7744 RECORD OF PH.# 51 <br /> .CLIENT I CONSULTANT: , UAL Z�.-- P.O.#I INVOICE# <br /> � -� ANALYSIS REQUESTED SITE SAMPLE MAP <br /> PROJECT/SITE NAME (17EMIZED AND CREaXD BELOW) � �?�u'd"' <br /> r � T(NORTH) <br /> U <br /> � ��p Jaz 'b CO W o 2z cr <br /> Y <br /> STREET: f(�fp`111 CITY: STATE: o < � <br /> ;5 <br /> V w O J Lu <br /> I�VIA: s Q J VV <br /> SAMPLER:mRwrE'D SIGNATURE) AYBILL� N W a <br /> � o Lu <br /> o <br /> NUMBER TYPE = y a a yC o 0 0 U <br /> SAMPLE LOCATION DATE TIME SAMPLE <br /> (►DSNl►F1CAT►ON) MTHJDA1711t SOUP/MIH. OF (CRA&OR MATRIX O- CL ro N N <br /> aoNTiuNERs cooMros►Ta) r- m ao ao m REMARKS/ SPECI�N TRU®IONS BELOW <br /> 2.) JW4- AES- '5 1-7�t-'3 <br /> 3.) �wo- w- 6s l28 I <br /> 4.)h%w-- D%S- 6 J-730 <br /> 5.) ,- .01 <br /> 1 D <br /> f7 S 1151 <br /> 9.) 1,,,,,I -- D - v11155 1 <br /> DL�L <br /> »SAMP18lNTEGRMI CONDITION&TVRNApOVND 77HE �• <br /> RECEIVED COLD A iNTACT ! YFS NO } <br /> N H:Dn'Y:�+cw ATE/TI;SE ED BY:a:rwrvan E!TIME: PRESERVATIVES USED ! YES NO } <br /> CUSTODY SEALS INTACT/ YES 1 NO TVA <br /> AIR BUBBLES IN V.O.:S ! YES { NS1.� LINE I <br /> :0Xi TlaR !TIME: RY�7 ED BY:cwwnr[ IML <br /> TURNAROUNDT►A!E: CUECKONF. <br /> RELIYQCISIIID !TIME: RECEIVED III I.AlIU1G1 TUBI':exon 1lYR.kO,n,.nxu )ATE 1 TIMF_- 1-IIUI?It 16-IIOUR � s-DAY /11-DA} } <br /> NOTE: LABORATr-Rv SAMPLE ARCHIVING WILL BE 30 DAYS FROM THE DATE SAMPLE W COLLECTED,UNLESS OTHER ARRAINGEMEIN'TS ARE MADE. <br /> P—.r£RE"'_. 'HS 1---HEST--t BLV—' �,AS---IAS BLEE'- .:ANK _� 1 C.0 � - <br />