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SAMPLE CHAIN A CUSTODY RECORD <br /> DEL-TECH GEOTECHNICAL SUPPORT (PLEASE PRINT) Lab. Analysis by : <br /> 10624 OLIVE AVE. OAKDALE, CALIFORNIA 95361 a LAB. INVOICE TO : pis1'rtsLW Y65[,A­' <br /> OFFICE (209) 847-8757 <br /> FAX (209) 847-7744 RECORD � OF� PH. # NIP I ��} _ <br /> CLIENT 1 CONSULTANT: M.AA P.O. #/INVOICE # <br /> ANALYSIS REQUESTED � SITE SAMPLE MAP <br /> PROJECT f SITE NAME: G,lJ1}1 d� (ITEMIZED AND C9ECXED BELOW) a <br /> (NORTH <br /> I <br /> Z U cn L'� <br /> ft DC3 <br /> STREET: CITY: �F�` "� STATE: ( ¢ ¢ cc: ., <br /> .n <br /> >(D c� p rr • <br /> pCD CC W <br /> co <br /> HIP VIA: C:) c= <br /> SAMPLE ED SIGNATURE) i WAYBILL A z <br /> o o (D a ¢ <br /> c w Q a X w �3 a <br /> SAMPLE LOCATION DATE TIME NUMBER 7}PE SAMPLE o =W x o <br /> uj <br /> 0 0 <br /> OF (GRAB OR 2 za <br /> (108NT7FlGTION) A!I&JDAY!}7t SOUR/M1N. 1 INATRJx 00 co� I-- - <br /> � <br /> m REMARKS I* SPECIAL INSTRUCTIONS BELOW <br /> i <br /> }) - 9-7 Zg �2_ <br /> z-) rvtw— 3 1 1V7 35 <br /> 5 z <br /> 3.) ' v`�l.) I 1-77 D Z <br /> 4-) DETISTIC, WeL ° -j 95 Z., <br /> 5.) f �n1L ( 7 b7 W L <br /> 6) <br /> AL <br /> 9.) <br /> *L­­ <br /> ' / S MPIE INTEGRITI'I CONDITION A TURNAROUND1/91 �/L q f q� RCEIVEDLULU dINTACT 1 YES � ;v0 <br /> ELI QU HEATEf TIME: lO RECEIVE DATE!Tl 1611 F:' V PRE_SRRVATl\'F-S USEHl//j }'ES IJ NO ai <br /> `T ('USF01)}'SFAIS[NTACI'J YES A0 L NIA <br /> AIR HUHBLFS IN Y.O.A,•S ) }'ES ` } NO LENE F <br /> EL 'QUISHED SY.-au T.w )ATE/TIS11S: RECEIVED B}':,Soy:n..T.wee )ATE I TIME <br /> JJ TURNAROUND TWE: ('IlECti ONE <br /> REL1S'(II;ISHF.I)H}':n!�:,..r.,e. MTE) 11\iF:: I 11'!'[J1--'} �r Xr 11/! \,r i r!,!Y )AT 7'I}1F:-1I�' '--1- H-WR 4x-140OR } -Z-IIAti 10-11A1 <br /> NOTE: LABORATORY SAMPLE ARCHIVING WILL BE 30 DAYS FROM THE DATE SAMPLE WAS COI.LFCTED,UNLESS OTHER ARRAIN'''GEMENTS ARE MADL <br /> PLEASE RETURN DEL-TECH'S ICE CHEST AND-BLUE ICE AS SOOTS AS POSSIBLE, THANK YOU DEL-TECH FORM C.O.C- <br /> Pink - Field Cupy ! White & Yellow - To Lahorcltury with SamPleS 1 Yellow - Return to Client with Result <br />