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SAMPLE CHAIN ® USTODY RECORD 0 <br /> EL-TECH GEOTECHNICAL SUPPORT (PLEASE PRINT) Lab. Analysis by - -f -- <br /> 10624 OLIVE AVE OAKDALE, CALIFORNIA 95361 LAB INVOICE TO 'l`nAr(L-`� �-} -�r <br /> OFFICE (209) 847-8757 ladI ,IS7-Y- r7�i <br /> FAX (209) 847-7744 RECORD OF ; PH # ( >(5-9) <br /> CLIENT / CONSULTANT: Z, P.O #/ INVOICE# <br /> rr.. ,�, Ej;"� ANALYSIS REQUESTED SITE SAMPLE MAP <br /> PROJECT/SITE NAME WFQL� G! (ITEMMED AND CHECIED BELOW) <br /> (NORTH Lf <br /> en c <br /> LLI <br /> I U <br /> I � v m ca U i T <br /> STREET L 1 CITY �T��� STATE aL. Z o . <br /> �CD <br /> s W dl�` <br /> co CD IU G O cw <br /> 5 —T IiIP VIA T cO--p ct= 0 Z m i G <br /> SAMPLER tPRINrED SIGNA { AY$ILL# ` <a o L-) a <br /> cs <br /> NUMBER TYPE SAMPLE c0 cn x t x o 0 o v <br /> SAMPLE LOCATION DATE TIME OF tGxaaOR = a'- � v ti <br /> (lDBNTIFlGLTION) lursJf)tI7YR BOUR/MSN CONMMERS COMPOMM MATRIX co ar o CO 1� REMARKS I* SPECIAL INSTRUCTIONS BELOW <br /> t -6 I t= LE12- &-AY)�-- <br /> Z '— c <br /> 3� - <br /> 4)yvv-"o r 2r <br /> s, A— 5 -Z- W,192Ts <br /> �r '� �— L L, <br /> 7) 1�z - 1 <br /> B) <br /> `,r o►j-- 3 P�i— -4) <br /> L „SAMPLE IMEGRITI I CONDITION&TURNAROUND TIME '* <br /> 1�Dv l L� 1 c xl RECEIVED COLD&INTACT t NES � NO <br /> IN SHED BY nisc, ATE!TIME. V B! mcmi R t 4\i DATE TIME I PRESERAATIVESUSED ES (� NO <br /> U, <br /> f� C-USTODI SEALS INTACT <br /> !!!!!````����YESES ( NO { } WA <br /> f j AIR BUBBLES INV O.A'S / YES NO LINE 8 <br /> INQUISHED 61 FKrmTuau ATE f TIMEEC.EI�D BI DATE/TIME <br /> I URN AROUTIME CHECA OAT � <br /> Ef.INQLISIIFD BI esxvr,„[, ATEI TI111t ECEIVED R) LhRORATORY I,T[Tt*M"UL TIM[ ATFITIME :a HOUR � � 4A HOUR � � DA) ` � 10 DAI A <br /> M <br /> NOTE LABORATORY SAMPLE ARCHIVING WILL BE 30 DAYS FROM THE DATE SAPLE A'AS COLLECTED,UNLESS OTHER ARRAIN'GEMEIN7S ARE NI ADE. r <br /> PLEASE RETURN DEL-TECH'S ICE CHEST AND BLUE ICE AS SOON AS POSSIBLE THANK YOU DEL-TECH FORM C O C <br /> Pink - Field Copy 1 White & Yellow - To Laboratory with Samples 1 Yellow - Return to Client with Results <br />