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f U SAMPLE CHAIN OF CUSTODY RECORD <br /> DEL- ECH (;EO—I "Cl1NICAL SUPPORT W1,FASE PRINT) Lab. Analysis by : J�p�•���1�„_�_A �� <br /> 10624 MAVE' AVE.. OAKDALE,, CA1,ihORNIA 95301 LAR. INVOICE TO <br /> ()I F ICE, (209) 847-8757 <br /> FAX (209) 847-7744 REIC01M [)1'' 1'11, # a c. - <br /> CLICNT / CONSULTANT: Y L �' P.M # INVO Icr, # <br /> �� E� e 5 C �l ANA15SI S RE UL'S77i1) Sl7Yi SAMIL1i ALAN /n Ljq(NORTH <br /> PROJECT I SITE NAME: r f ITF.AII7.FD AND MA-CAT.D RF.IAU'Ip <br /> STREET:����5E CYC I V� f CITY: � � STATE',: <br /> 0 420 �e-Y 6t-\3k5[1 <br /> E <br /> I>VIA:oAMPLER:IrRINTEDSIGNATURE) YBILL p� ey ui Ob f _70 <br /> - <br /> SAMPLE <br /> P- 1 _7 t <br /> NUh1l3F_R T}'PE 4 S p 1T <br /> SAA11'1_E L OCATION DA TE' 7'lA�L vF 5Ah1Pf.1; I <br /> � {CRAR OR <br /> (lDEMlFlCATIDrT'1 AfTNfDAtYl'R. IlOUR/A1IN. oDNTA1NFR5 CYlAlP05lTE) h1A�R1 REMARKS/* SPECIAL INSTRUC ON.S BETON <br /> [ <br /> — a <br /> 6.) <br /> T) <br /> Y <br /> 9.) <br /> 10 <br /> 39) _=SAMPIF.1V1-FGRITr,('o,vnlTlov d FURNAROUAD T1r4lE _• <br /> ` J HECF,iN'F.0['U1.b R INTACT 1 SFS Nat ( <br /> RELINQ011-lEi3 B5':isx:H,n�xu - IATFI TINIE:�-Y�,(/'f K EI�'FU 85':a,uaenxa• 1ATE1 TIA1F_ 'S� i'KFSF,RPAT11'F_S i�SF,EI [ �'F:� hal 1 } <br /> CUSTODI SEA!N INTAU1 i 4F.5 ' NU NIA ' <br /> AIR BURBLES IN V.U.A.'S [ 1 E5 { � Nt..1 ( � LINE K <br /> H�[,N[ UISFIEh BS':.��,:r'�r )ATF1 TIME: '� RECEIVEDBl':�ti,:wnu )ATF 1 TIME- <br /> t � TN RA'AROU.NRTl,1fF,': fllF.aAu,1'F.' <br /> y1la-I1. C�RF' N(Jf'.FSRFDIt\':.,r,.....,,x IATFrTi��fF::� '�j I L•11Idl'LAIMRATUH}':...,,,,�x,.x.,�,,.,,.�r. t,fTFIII%IF.: . ' Inf'u { ax.Irut-u -trA1 In-trAv <br /> \61-1?: I,A110RATORY SAMI'Ll':ARC'HINA1V1: WILL 111?311 DAYS FRII\1 T111•; 11ATI.” wm,, L:TIf,I,I;C"11';11. 1 \1.1'.SS 0111FIR ARRATMA11.1\tl':N'1:S ARF, MADE. <br /> I'i,F,ASI?RI.-TURN Ui?L-I'FCII'S ICH C:IIEST AND IILl1I': ICI;AS SOON AS VOSSIRI,li. 'THANK 1'Ilt' 111;1.-')1';1:11 FIIR V l'.I1.{'. <br /> Pink - Field'Copy / While & YcHow - To Laboratory with Samples / Yellow - Return to Client with Results <br />