Laserfiche WebLink
SAMPLE CHAIN\--\ JVWUSTODY RECORD <br /> 4 0 9 1W <br /> DEL-TECH GEOTECHNICAL SUPPORT (PLEASE PRINT) Lab. Analysis by <br /> 10624 OLIVE AVE OAKDALE, CALIFORNIA 95361 LAB INVOICE TO <br /> OFFICE (209) 847-8757 <br /> FAX (209) 847-7744 RECORD OF PH # <br /> CLIENT / CONSULTANT: 1`�""'! - ' P.O.#I INVOICE# <br /> ANALYSIS REQUESTED j SITE SAMPLE MAP <br /> VIS Tro.rAW <br /> PROJECT/SITE NAME t (ITEMIZED AND CHECKED HEaow) (NORTH) <br /> � U y <br /> ' Uj z cc <br /> co <br /> STREET', 15bb �f "`r +ra m ¢ CC <br /> - <br /> CITY +" STATE >0 a <br /> a O a _ui <br /> j w <br /> No ICT == <br /> W> � LU m <br /> HIP VIA m o z a t� to <br /> SAM sIGNATURM AYBILL# ; °� 13 w m ¢ <br /> C7 O O y 4 a LU <br /> w z I *'' � <br /> NUMBER TYPE Mp t� a = x c7 0 o L) <br /> SAMPLE LOCATION DATE TIME = = � CD cli r <br /> (IDENTIFICATION) AlTslDAm7t soup MIN CONTANERS �AIPo5IT81 MATRIX a fL cc m m I REMARKS SPECIAL INSTRUCTIONS BELOW <br /> 3) VD <br /> F <br /> 4) �' Y <br /> 7) <br /> s) <br /> 9) <br /> 10 <br /> «SAMPLE INI"ECRITS ICDNDffION&rURNARO!)NDTlME •' <br /> /q RECEIVED COLD t INTACT I I ES NO <br /> QUI HFJ]BY mr'H4 a ATE f TIMF_ RECEIVED Bl RICHATVIt[t ATE I TIM PRESERVATIVES USED SES NO { <br /> CUSTODI SEALS INTACTII I YES NO NAZ <br /> AIR BUBBI F-9 Ih Y OA 4 r YES i N[l LIhE R <br /> QUISHED Bti cmmT ATE!TIME ECEI\ED BS ,slcn.nKEl T�11 <br /> TURK ARMAD TIME CHECK O,YF <br /> ]pL �y <br /> I�C17/ `{a Q ECEII�` O � j� / 27 IfUUR 18 HOUR { UAS 10 VAI <br /> k .%IED Bl 61.-TLIKE, _ ATE I KK!!ii 4TE TI kh RO MT1.E ATF 1 TIME D <br /> ROTE ` ORATORY SAMPLE ARCHIVING WILL BE 30 DAYS PROM THE DATE SANIPLE WAS COLLECTED,UNLESS OTHER ARRAINGEMEN"I's ARE MADL DEL-TECH FORM C O C <br /> PLEASE RETURN DEL-TECH'S ICE CHEST AND BLUE ICE AS SOO\AS POSSIBLE THANK YOU <br /> Pink - Field Copy 1 White & Yellow - To Laboratory with Samples / Yellow - Return to Client with Results <br />