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Client <br /> DEL-TECH _ SAMPLE CHAIN OF CUSTODY RECORD Address 1 Qn- 1 '5 LD, <br /> Geotechnical Support Services (please print) D Phone No _ <br /> �� Proj. MgrdContact L L1Ir,� <br /> 10624 Olive Avenue <br /> Oakdale Calif. 95361 Pink-Field Copy <br /> 209 847-875T White and Yellow-To Laboratory with Samples <br /> ) Record J—of Yellow-Return to Client <br /> f P <br /> PROJECTlSITE NAME: .L1-7 ., I ANALYSIS REQUESTED <br /> Wi <br /> PROJECTICONTRACTIPO NO.: <br /> NAME 0 SAMPLER: 4 Q~ r REMARKSISPECIAL INSTRUCTIONS <br /> l <br /> LAB USE LY SAMPLEa ^ m NUMBER <br /> Q :: OF i <br /> LAB I.D. I.D. DATE TIME 0 CON- <br /> 0 c7 TAINERS <br /> w- x x x I I I <br /> -t> BILL Z <br /> i <br /> E <br /> �? P J A 1 <br /> C t a Ion:) <br /> INVIRONME TAA �# <br /> M <br /> c-z <br /> c <br /> RELINQUISHED BY SIGN DATErTIME RECEIVED BY SIGN DATE[TIME RECEIVED FOR LABORATORY <br /> 7 BY.(SIGN): DATEfTIME <br /> F' <br /> RECEIVED: <br /> LD AND INTACT OTHER PRESERVATIVE DYES ONO <br /> ❑OTHER: <br /> `r TURN AROUND TIME: <br /> SHIPPED `.' OFED X ❑UPS >�)THER: # SHIPPING` ER NO.: [324-Hr 02•Day 05-Day Day <br /> x. <br />