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SAMPLE CHAIN CUSTODY RECORD <br /> DEL-TECH GEOTECHNICAL SUPPORT (PLEASE PRINT) Lab. Analysis by <br /> 10624 OLIVE AVE. OAKDALE, CALIFORNIA 95361 LAB INVOICE TO �ELJ UJ Ab LE5A _IE W4 <br /> OFFICE (209) 847-8757 —FAX (209) 847-7744 RECOR A--OF PH. # { ) <br /> CLIENT / CONSULTANT: kv ! �� P O. # INVOICE # <br /> WA_ �Tml n 6--w ' v {'��-" ANALYSIS REQUESTED SITE SAMPLE MAP <br /> PROJECT I SITE NAMEti T�-)u s ba � i-C l rrEMIZED AND CBEC�n BEI.ow) - RrH <br /> to w <br /> C r Lv1 ji h,11 LI Jc)r' <br /> z U) LJ <br /> cv <br /> STREET: � m 6Y1 1` CITY: STATE . U a CI,cc 2f <br /> 5 9 � w r <br /> HIP VIA ¢' 4� a"D_ Iz T Q J <br /> SAMPUs[clvAlvxx» AYBILL a1 �"'� ; �` W ¢ c~a J 1 ! <br /> �C) cc <br /> a <br /> Qo Lu a a �c w <br /> SAMPLE LOCATION aLATLTIME NUMBER iYPE <br /> SAMPLE = a c o <br /> OF {crAr or <br /> (ID8N7TFTG1TlON) 9DuriMfM � � � ) MArR1'X � m 00 cow c REMARKSI* SPECIAL lNSTRUCTTONS BELOW <br /> I - ZZ B <br /> -3 Z <br /> 4' Ughrj B10- 14"'ATl;-Pl- f—1 <br /> B <br /> C�M <br /> 79 q <br /> 8) <br /> 9) <br /> 11] ~ Y ! <br /> sA,HrtB INTEGWT}I COMMON s TURNAROUND TIME ** 1 <br /> /12��j(, <br /> n+� J RECEIVED COLD&INTACT ! }F.S � NO <br /> H�BY ,srr kr ATE!TIMFN/ EI VED 8} a�,.n,.k, ATEI TIME i PRESERVATIVES USED I-V[A/YE,S (,ef NO { E <br /> CUSTODY SPA IS INTACT / YES { } Nt7 (r )y NIA 11 <br /> AIR Bl1BBLES INV OA S I YES ) ND { � IANE 1 ' <br /> RELINQUISHED81 aW TVkl ATE/TIME: REC ETN ED B} s,r.yTu�n ATE I TINIF VI <br /> TURN AROUND TWE CII£CA 0 V <br /> E <br /> REI INQLISIUD BI- DATE/T1%I} 1_CE_IYh_D H} I_4BoR�tTOR1 wTe nATt I TIMI- ', IIUt�k { ae 1110UR { VA% 1 ) 16 DA} <br /> NOTE LABORATORY SAMPLE ARCHIVING WILL BE 30 DAYS FROM THE DATE SAMPLE WAS COLLECTED, UNLF,SS OTHER ARRAINGEMEN'TS ARE %1ADE_ <br /> PLEASE RETURN DEL-TECHS ICE CHES F AND BLUE ICE AS SOON AS POSSIBLE THANK YOU DEL FECH FORM C 0 C <br /> Pink Fidd Copv / Whin & Ycfiow ro t iborator� kNih Sampl« / YLIIUW RUM11 �0 E11u1( %�i(h RctiDlt,. <br />