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SAMPLE CHAIN A CUSTODY RECORD <br /> DEL-TECH GEOTECHNICAL SUPPORT (PLEASE PRINK') Lab. Analysis by 10624 OLIVE OLIVE AVE OAKDALE, CALIFORNIA 95361 LAB INVOICE TO <br /> OFFICE (209)847-8757 <br /> FAX (209) 847-7744 RECORD_]_OF�_ PH.# 3 <br /> CLIENT/ CONSULTANT: P.O.#i INVOICE# <br /> W Ak1V9L%1 ANALYSIS REQUESTED SITE SAMPLE SfAP <br /> PROJECT/SITE NAME (IMMIZED AND CHECXED BELOW 7" � <br /> • (NORTH) <br /> cn <br /> Z3 <br /> �L J Q Z s t <br /> STREET CITY STATE < <br /> v 1 i o m 6 ` <br /> a� ¢ cc <br /> 1. <br /> CIS ,n pate[ Q <br /> � m <br /> HIP vu: <br /> p <br /> � oWr <br /> SAMPI� <br /> SIGNATURE) AYBII.L: L Q a o <br /> o j !< W <br /> P 4 a <br /> fr W2 w <br /> SAMPLE LOCATION DATE TIME NUMBER TYPE SAMPLE _ x o CD o v <br /> (LDENTIFICATloN) Af78JDAYi7A BOVR/AfiN aoN7xlNSRs � } MATRIX F--cc: m w co F~ REMARKS/*SPECIAL INSTRUCTIONS BELOW <br /> I)hkJt�1— b dD ! = L <br /> 4) L QUATM 6F <br /> 5)%-Mw— z P9 IM u E Flew LZ 6 A <br /> LI, 4-1:. <br /> 7) P U*AV- L D v `' z b 5 5, <br /> 8) <br /> 9) <br /> 10) <br /> hBy <br /> SAMPLE INTEGRI n/CONDITION&TURNAROUND TIMERECEIVED COLD&INTACT 1 YES NOI d±tf± <br /> IN SHnu ATE l TIME y EC ED 111 taiceuna a ATE I TIME PRESERVATIVES USED�JL, S ES NO <br /> CUSTODY SEALS INTACT I YE.S S NO NIA <br /> AIR BUBBLES IN V O.A'S / YES NO LINE I <br /> RELINQUISHED BY ammnmi, DATE I TIME IRECEIN ED 61 DATE I TIME. <br /> TURN AROUND TIME CBECA ONE <br /> !ELINQLISHED Bl om r.wm DATEI TIN%F_ XEIVED BIS LABORATORI' mottn�mmunnnMr ATfi/TIME 24 L <br /> HOUR i8 FLOUR t DA1 { r 10 DA4 <br /> ROTE LABORATORY SAMPLE ARCHIVING WILL BE 30 DAYS FROM THE DATE SAMPLE WAS COLLECTED,UNLESS OTHER ARRAINGEMENTS ARE MADL <br /> PLEASE RETURN DEL-TECHS ICE CHEST AND BLUE ICE AS SOOT'AS POSSIBLE THANK YOU DEL-TECH FORM C O C <br /> Pink - Field Copy / White & Yellow - To Laboratory wi(h Samples 1 Yellow - Return to Client with Results <br />