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SAMPLE CHAIN OCCUSTODY RECORD <br /> DEL-TECH GEOTECHNICAL SUPPORT (PLEASE PRINT) Lab. Analysis by : -L1 <br /> 10624 OLIVE AVE. OAKDALE, CALIFORNIA 9536I LAB. INVOICE TO :_yw�gc n� <br /> OFFICE (209) 847-8757 <br /> FAX (209) 847-7744 RECORD OF PH.# <br /> CLIENT 1 CONSULTANT: NaC .• P.O.#I INVOICE# <br /> }YR �1 �` ANALYSIS REQUESTED SITE SAMPLE MAP <br /> PROJECT!SITE NAME: %}VR t (ITEMIZED ANDCHECI'RDREWOW) fMOTTOdC1�� <br /> (NORTH <br /> _. __. —_.. ._ _ 0 4m4°° a <br /> AATo S4 '� ,a ,� —w <br /> STREET:" CITYe T =� "STATEcI�i - -�' �-` <br /> CD Ln 0 cc <br /> LLj <br /> HIP VIA L T�ecA m o= LU <br /> a <br /> SAMP : R1NTED SIGNATURE} WAYBILL# <br /> N <br /> o� o M or 4 <br /> C:) <br /> w = o i IVv"Ire <br /> SAMPLE LOCATION DATE TIME NUMBER TYPEMp t7 0 =„ ac o 0 o v <br /> -'-'(IDENTIFICATION) - MTHJDAVI'I4 HOUR/MIN. ° - (CRAB 0R -MATRIX 0. a - -CD - N'- c^ <br /> .I 'J - - - - <br /> CONTAMERS G>7MPOSITE) F— m co 00 co F- REMARKS/* SPECIAL INSTRUCTIONS BELOW <br /> 15 - 4km vrptp—, rx X' _iw LM 6tA <br /> 3, 11 RMN )LEL MAn <br /> 6.)X'-RW <br /> 7 a Lro Y-- IL <br /> 8.) I <br /> 9.) L hsAf <br /> ltl.) <br /> MAIM INTEGRITI'1 CONDITION TURNAROUND TIME •• <br /> RECEIVED COLD&INTACT ! YES NO ( } <br /> UISHEDBY:unADATE ITINIE:` RECEIVEDBY: DATE TIME- PRESERVATIVES USED I YES NO <br /> CUSTODY SEAE_C INTACT I VES ( } NO ( Nlp <br /> AIR BUBBLES IN V.O,A.'S ! YES ( NO LINE#- <br /> _r <br /> RELINQUISHED 6!':Frfurimu ATE/TIME: RF1C�.'H VSD BY �icw,n�q ATEl.T[ME: <br /> ._.l�,�c I y TURN AROUND TIME: CHECK ONE <br /> [RELINQUISHED B!':.sh:�.anncE, ATE!TIM E: I'' Ii'F.0 hl'LA80�ORrf Tt'h- n,•o��.Mf, �/ jyj{g: .'4.HOUR } ,s-IIUUR { _-DAY 10-UAS' { , <br /> NOT LABORATORY SAMPLE ARCHIVING WILL BE 30 DAYS FROM HE DATE SAMPLE WAS COLLECTED,UNLESS OTHER ARRAINGEMEN'TS ARE MADE. <br /> PLEASE RETURN DEL-TECH'S ICE CHEST AND BLUE ICE AS SOON AS POSSIBLE. THANK YOU DEL-TECH FORM C.O.C. <br /> Pink Field Copy I White & Yellow - To Laboratory with Samples 1 Yellow - Return to Client with Results <br />