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SAMPLE CHAIN OF CUSTODY RECORD <br /> DEL-TECH GEOTECHNICAL SUPPORT - (PLEASE PRINT) Lab. Analysis by : <br /> 10624 OLIVE AVE. OAKDALE, CALIFORNIA 95361 LAB. INVOICE TO : <br /> OFFICE (209)847-8757 -LA-1-4- <br /> FAX (209) 847-7744 RECORD_A _OF _ PH.# <br /> CLIENT/ CONSULTANT: L P.O.#I INVOICE# <br /> 7, <br /> PROJECT/SITE NAME: D I I ��� ANALYSIS REQUESTED SITE SAMPLE MAP <br /> (ITEMIZED AND C$ECIED BELOW) VW TOWAM <br /> (NORTH <br /> uj z w N <br /> STREET: f 1 CITY: 1"u1 STATE: 1 o m <br /> C.3 <br /> ac z <br /> L " uu c t� c a // p\\�� <br /> tA <br /> 7 p Lu <br /> � o y <br /> D W J <br /> FAY SIA: ¢= Q J a g5 . <br /> SICIVATURR) BILL# = N w <br /> 4 w CD < aaC .f1�.1ID <br /> • `� a g o a a �c 1 n"r <br /> SAMPLE LOCATION DATE TIME NUMBER TYPE SAMPLE �; o ' r. x a c o c�, 1 <br /> �c z a a <br /> (IDBNrIFIcJtrlox) MTBJDtY/17I sour/MIN. avMuxERs ���� MATRIX F F m aur c .m R,EMARKS/*SPECIAL INSTRVCTIONSBELOW <br /> 2) U 1�� L <br /> 4•)1' -A> <br /> 5.)W1 <br /> z "2— <br /> list, <br /> . ; 6t E <br /> -2, <br /> 9-)YYvJ— ck <br /> to. a — ►� y Cj b U L. <br /> 2�� L J 3�3 ps SAMPL£1NlEG1tII1'/UDNDIIYON f TilRNAROUND TIME u <br /> RECEIVED COLD R INTACT 1 YES NO <br /> SHEDS DATE IT1ME`1tt> RECEIVEDBY;oiGmrun ATE/TIME PRESERVATIVES USED LYES 1Jl NO <br /> CUSTODY SEALS INTACT I YES NO , WA <br /> AIR BUBBLES IN V.O.A.S / YES ( } NO�WNE a <br /> RELIN ATE/TIME: RECEIVED nxi, A ME <br /> TURN AROUND TIME: CBECA ONE <br /> RELINQUISHED BY: ATE I TMII:4 RrCEIVED III'LAHORATORY:a01T T(v+.moum vmg ATE/TINE.• 2.1•HOUR } AR-HOUR } 5-DAY Y i 'I•DAY <br /> !' BORA`11-SAMPLE ARCHIVING WILL BE 30 DAPS FROM THE DATE SAMPLE V,,_< COLLECTED,UNLESS OTHER ARRAINGEMEl�'TS ARE IN ADE. <br /> .-. 'SS <br /> F- RE � 1 -_-iiES�v_�BLi `_:AS—"—Z AS`-"1BLi! ANK ``— `� � _ � -.d G( <br />