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k51qcT,-W, ?m = mSAMPLE CHAIN CUSTODY RECORD <br /> DEL-TECH GEOTECHNICAL SUPPORT (PLEASE PRINT) Lab. Analysis by <br /> 10624 OLIVE AVE. OAKDALE, CALIFORNIA 45361 LAB. INVOICE TO <br /> JU— <br /> OFFICE (209) 847-8757 <br /> FAX (209) 847.7744 RECORD �OF PH. # <br /> CLIENT / CONSULTANT: Lx �jw IFS' - P.O. #/ INVOICE # <br /> } ANALYSIS REQUESTED SITE SAMPLE MAP <br /> O <br /> PROJECT I SITE NAME: �� Lj 1 (ITEMIZ&O ANn CHECKED BELOW) "°r"°"""' <br /> INORTII <br /> � N <br /> STREET: CITY: STATE: i. rr =z <br /> .n �o tr p <br /> O Ln ¢ Ow Co -1 l <br /> l b- T HIP SIA: ,r � _m a M Q <br /> ff <br /> SAMP :(PRINTLFCNATURB} AYBILL N uj <br /> o� w -,� V Q <br /> CD Q oo <br /> SAMPLE LOCATION DA IF, TIME NUMBER (o:e iB oR =D <br /> SAMPLE z s a a- IX- o <br /> (rosxrlFlcArIoN) ArrHJDArn'R >fOu</MlN. �A,=� aosrPoslrE) MATRIX 1-- a co co REMARKS SPECIAL INSTRUCTIONS BELOW <br /> ,.) -�' lL D 3 Csw�c� <br /> 2.) <br /> 3.) <br /> 4.) <br /> r <br /> i <br /> 6.) , <br /> 7.) <br /> g.) <br /> f <br /> 9.) <br /> SAMPLE INTERRITI•/CONDITION s TVRNAROUND TIME <br /> RIPA-P,IVED COLD A INTACT I YRS NO ( } <br /> 6 IiNQ SI(8D BY: ., rvrr� ATE!TIME:��D RRCEIVED BY: DATE I TIME- PRFSERVATIVFS USED E.S <br /> CUSTODY SEALS INTACT//! YF,S } NO WA Jbd <br /> AIR BUBBLES IN V:O.A.1S I.YES Nrf w LINE 11 <br /> ISIISv BY: LATE/TI •RE(7EIVRID DATE TIME: - <br /> 1z TURN AROUN)TI AIF: C!lEC7C ONF. <br /> / 1 / ECF14' U IIIA!./1BURATO :Knorr n•xH.aoura.s,Mr� )ATE!TIME: HOLM IR,.110UR 10-IlAY } <br /> REI Q1�15IIFD BY:F.:�.*�'•�� DATEI TIME: �tb <br /> NOTE: LABORATORY SAMPLE ARCHIVING WILL BE 30 DAYS FROM THE DATE SAMPLE WAS COLLECTED,UNLESS OTHER ARRAINGEMENTS ARE\1ADF <br /> PLEASE RETURr <br /> pFL-TECH'S ICE CHEST AND BLUE ICE AS SOON AS POSSIBLE. THANK YOU DEL-TFCII FORM C.O.C. <br /> T'ink Fir LI f nn, I Wh;W R, Yr11nw - To I nhr,rilnrr' wilh .Samnlr,� I Yrllow - Rrlilrn to C lirnl with Rrst111s <br />