Laserfiche WebLink
SAMPLE CHAIN O CUSTODY RECORD <br /> 4IL-TECH GEOTECHNICAL SUPPORT (PLC PRINT) Lab. Analysis by <br /> 10624 OLIVE AVE. OAKDALE, CALIFORNIA 95361 LAB. INVOICE TO : L..`Tec44_ D� <br /> OFFICE (209) 847-8757 . <br /> FAX (209) 847-7744 R COR©J_OF PH.# <br /> CLIENT / CONSULTANT:VALLE11 P.O. #I INVOICE# <br /> v4L ANALYSIS REQUESTED SITE SAMPLE MAP <br /> PROJECT/SITE NAME: �� I �1 �`` SfW vn�6 (nEMITEDAND CSECVD BELOW j aorm`c��ti (NORTH <br /> v, cn sn "a <br /> LU ZW L2 <br /> STREET: �{1 W Vii`�Q' TCTTY: STATE: 0 ¢ Q 0 Ne <br /> cm mo <br /> = O - <br /> LUo zS <br /> o <br /> N 1..1{r' LU <br /> HIP VIA: W oQo �= <br /> SAM Rat1FD SIGMTURB) WAYBILL# Q cam, < �' o� <br /> • , , cc iJJ = d XW <br /> SAMPLE LOCATION DATE TIME [COISTA <br /> BER ( R SA�ytp1� z ya(IDENTIFICATION) AfIJTJDAriYR HOUR/AlIN. NERS aDMI'osllTi j MATRIX � � I­ m ED � W � REMARKS/* SPECIAL�RUCTIONS BELOW <br /> I.)WAA- <br /> 2.) � _6 Z i <br /> 3.) t +1�� W l LL <br /> 4.) — J �i V FIi1Lt' <br /> s') YLJ r�- KIP I 15 11 <br /> 6-) Z <br /> 9., S <br /> 10 <br /> ,� ,� - a 9� •=S1UPISIMTEGRITYICONDITION&TURNA1WUNDTIMF '� <br /> i RW.EIVED COLDS INTACT 1 YF.S .''O } <br /> REIJ QUI HED BY:ax:rca ATE I TIME1I'� RECEIVED BY:rsieeus , ATE I TIME:: I PRESERVATIVES USED 1 YES 1 } NO { <br /> CUSTODY SFALS INTACT I YES ( ) NO NIA { <br /> AIR BUBBLES IN V.OA.'S I YES ( NO { LINE N <br /> UISHED BS':EN:winiae,DATE TIME: A E!71ME: <br /> . TURN AROUND TIFfE: CNECAONE <br /> R 1NQL'tsllt 8�.6N:.1'�Tlmt, ATE1 7`D TIMF_� ECEI� U BY L4 BORA TORI�:'. rn'"NAkourr TME, ATEI TIME:C/ -'a 1101"R } tR HOURUn 1' ( , 1D DAY } <br /> ROTE: LABORATORY SAMPLE ARCHIVING WILL BE 30 DAPS FROM THE DATE SAn'IPLE WAS COLLECTED,UNLEiS OTHER ARRAINGEMENT5 ARE MADE. <br /> PLEASE RETURN DEL-TECH'S ICE CHEST AND BLUE ICE AS SOON AS POSSIBLE. THANK YOU DEL-TECH FORM C.Q.C. <br /> Pink - Field Copy / White & Yellow - To Laboratory with Samples / Yell)w - Return to Client with Results <br />