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SAMPLE CHAIN OWUSTODY RECORD / <br /> 4S : 5f naN �_j 1 .1 <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: P.o. #/ INVOICE # _ �.� <br /> ANALYSIS REQUESTED SITE SAMPLE MAP <br /> mor ro cc.u� <br /> PROJECT!SITE NAME: � � �� (rTEMMZED AND CHECKED BELOW) (NORTIi <br /> o a)m v a <br /> STREET: 1 �, CITY: �� STATE: o 4 � o <br /> O C) 11J <br /> `l� ` `` �LT CSO cn LLj _1 N <br /> pbo u�rR 1 <br /> SHIP 5 o ¢= o z m ra- J 3 <br /> �, �, a c� a <br /> SAMPLER:(PRINTED sIGIYATURBj WAYBILL o f � CD it F F_ <br /> c7 a o ¢ a <br /> ac I)i uI <br /> SAMPLE LOCATION DATE TIME (7YP oR ;til (D _ CL Lu X C) 0 <br /> !msRmFrcArroN I MTHJDAS%YR. sour r llrrx. JI1ATI IX " Fa M CO m co I- REMARKS/* SPECIAL I STRUCTIONS BELOW <br /> 0517E 2A o6"6 vm $ Lam, B y A <br /> Z, -- Z �I1 <br /> pyf <br /> ;'•r <br /> lbs <br /> 4.) Z ? r <br /> 5, _3 72 3 <br /> 7.) -In i, p n 1 U " D '' <br /> $> <br /> 9.) <br /> !0 <br /> ��� � �� / 1�'L�/�A ••S4AfYl6/MEGRIM/COA,DITfON&TURNAROUND TIME •• <br /> RECEIVER COLD&INTACT 1 VFC A N0 <br /> r J i <br /> *� ATEI TIME: PRESERVATIVES USEDk/L YES NO <br /> INQ lSHID BY:a .w Ri, ATE i TIM - .� RECEIVED BY:isocwrv�n <br /> CUSTODY SFaLS INTACT I YES { NO NA <br /> AIR BUBBI.CS IN V.O.A.•S I YES NiI LINE R <br /> RELINQUISHED BY:,pLWTUF DATE Tf1M RECEIVED BY:aecnari - )ATEI TIDSE: <br /> TURA'AROUND T!AlF.: CIrECK O,VF <br /> ' �. `r )ATEI7"I�1F: (� i'CF1I tb 11)'L4HORATORY:a T[TV—­v,rimt, )ATEI TIME: �'DlL !-4•IIUI!R � � 'R-HOUR � } _-PAY � � 10•DAY <br /> R ANQUISFli'A Bl:6.: <br /> DOTE: LARORATORI'SAMPLE ARCHIVING WILL BE 30 DAYS FROM THE DATE SAMPLE WAS COLLECTED,LNLESS OTHER ARRAINGEMENTS ARE\IADP:- DFL-TECH FORM C.O.C. <br /> PLEASE RETURN DEL-TECH'S ICE CHEST AND BLUE ICE AS SOON AS POSSIBLE. THANK YOU <br /> Pink- F;c1d Co nv I Whitc I,ahorauory with S:o,1111; 1 Y(-Ifoxv - Rclurn In ('! ._nt with Rosll4ls <br />