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SAMPLE- CHAIN OF CUSTODY RECORD <br /> DEL-TECH GEOTECHNICAL SUPPORT - !PLEASE PRINT? Lab. Analysis by <br /> 10624 OLIVE AVE. OAK©ALE, CALIFORNIA 95361 LA§. INVOICE TO :A <br /> OFFICE (209) 847-8757 D L1V <br /> FAX (209) 847-7744 . RECORD OF_1___ PH. # <br /> CLIENT 1 CONSULTANT: LES Z . LW - ���`�LL ��� R-iN p.o. # / INVOICE# <br /> - : , - <br /> ANALYSIS REQUESTED SITE SAMPLE MAP <br /> scAeei:. ., <br /> 4 - -/f'!^W—*��'V�✓. 1 (Il'EM17•ED AND CHECXED BELOW) ,., _ <br /> PROJECT SITE NAME: _. ---- - <br /> STREET: CITY: STATE: L/ <br /> �1 1_L1 HIP VIA- <br /> AIR <br /> IA- <br /> r <br /> Ut3"i� AYBILL# \��] <br /> A :(PRINTED SIGNATURE) ac <br /> r�+ <br /> NUMBER TYPE SAhrPLE <br /> SAMPLE LOCATION DATE TIME OF (GRAB OR MATRIX "" Q REMARKS/�` SPECIAL INSTRUCTIONS BELOW <br /> (IDENTIFICATION') MTH.IDA17}'R. HOUR/MIN. CONTAINERS COMPOSITE) <br /> xi T <br /> 2.) <br /> Nb ia� Tb <br /> RIA ur <br /> 6.) <br /> CA7J <br /> 9.) <br /> 10) !a *SAAIPIE Ie}TEGRITY I CONDITION&TURNAROUND TIME <br /> till q% RECEIVED COLD&INTACT ! VEST 1 NO <br /> ATE!TIME A�RECEIVE BY:ammnr xQ, ATE 1 T1P1E: PRE.SERVATR'ES USED V}'ES NO <br /> REL !,SHED 1 TUFF, - , <br /> r _ CUSTODY SEALS INTACT ! VES � � NO { � NIA <br /> ff 2 f(45 A[R BLBBLES IN V.O-.A.'S ! }'FS } NO LINE I- <br /> t.u ATE I TIME: <br /> ELINQUISH B}':61—TUNE, ATE 1TIME: RECEIVEDBY: Bcn.TURZF TURNAROUND TIME: CHECAONE <br /> ATEInn1E, RECEIVEDBYLABORATORY:,NOTETtFti.FUU!✓•1T,>PF, ATE/TIM E: <br /> 24.HOUR } 48.HOUR 5-DAY { } 10•DA <br /> RELINQUISHED B}:6n:NAT1*E, <br /> NI1TE: LABORATORY SAMPLE ARCHIVING WILIs RE 30 DAYS FROM THE DATE SAMPLE WAS CI)I.LECTEq,UNLESS(YT1 FR ARRAINGEMFNTS ARE MADE. DEL-TECH FORM C.0.C. <br /> PLEASE RETURN 1)F:i.-T'ECH'S ICF CHEST AND BLUE WE AS SO()N AS POSSIBLE. THANK YOU <br /> Pink - Field COPY / White & Yellow - To Laboratory with Samples 1 Yellow - Return to Client with Results <br />