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SAMPLE C14AIN Ok CUSTODY RECORD <br /> DEL-TECH GEOTECHNICAL SUPPORT (PLEASE PPJNT) Lab. Analysis by <br /> 10624 OLIVE AVE. OAKDALE, CALIFORNIA 95361 LAB. INVOICE TO : ILL <br /> OFFICE (209) 847-8757 �-' ie jtf } <br /> FAX (209) 847-7744 RECORD OF PH.# <br /> CLIENT I CONSULTANT: L P.O.#i INVOICE# <br /> ANALYSIS REQUESTED SITE SAMPLE MAP <br /> �1�� �r porTo�uu; <br /> PROJECT I SITE NAME: (ITEMIZED AND CIFECXED BELOW) (NORTH) <br /> u7 � <br /> �p v LLJ O U Z G <br /> STREET: '1\.i CITY: STATE: ag a <br /> U <br /> co U,U Lu m <br /> ��YA:V HIP VIA: C a= o" s m <br /> ui <br /> SAMPLER:C49$ICNAT6 AYBILL# sit o w m v a"c Q F <br /> ~0 ui s a <br /> SAMPLE LOCATION DATE TIME <br /> NUMBER TYPE SAMPLE Lu <br /> cm C) s� x a c) o v' <br /> (ADENTIRCATION) MTRJDA t)77L sOR <br /> oUR r NrrN. C17NTAINERs anMroslTs) cm <br /> MATRIX F mEL CL mr <br /> REMARKS/* SPECIAL INSTRUCTIONS BELOW <br /> s. 0 <br /> 4•) <br /> 5.) <br /> 7) <br /> 8.) <br /> 9.) <br /> 10.) <br /> SAMPLE INTEGRITYI CONDITION&TURNAROUND TIME.�a <br /> RECEIVED COLD&INTACT I Yu NORMEL { } <br /> { QU HED BY:cisw : u DATE11FINIE {� RECEIVED BY:gu=� E!IIME� PRESERVATIVES USED I YES NO i } <br /> CUSTODY SEALS INTACT I YES NO WA <br /> AIR BUBBLES IN V.O.A.'S I YES } N( UNE N <br /> LRELINQUIS1liH1 B'1 6k Twc TIME: ItEL; 1DATeTRIE. <br /> TURN AROUND TIME: C.IIFCKONF. <br /> INN ,aM:u svru !l.TE•l SSE: IiCFIYBD BI'1.f11J0RATo RIS: WT[n�h. .OL'M.TIM[I )ATE/TIME: 2J•HOUR NB•IIUUR 5-UA5'�_10-DAV <br /> NOTE.-'LABORATORY SAMPLE ARCHIVING WILL BE 30 DAPS FROM THE DATE SAMPLE WAS COLLECTED,UNLESS OTHER ARRAINGEMENI'S 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 />