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i♦ m mat <br /> i♦ i♦ <br /> AMPLE CHAIN CUSTODY RECORD <br /> � S < <br /> DEL-TECH GEOTECHNICAL SUPPORT (PLEASE PRINT) Lab. Analysis by : <br /> 10624 OLIVE AVE. OAKDALE, CALIFORNIA 95361 LAB. INVOICE TO : -1')YI (w Sq1 sr.;!" )P <br /> OFFICE (209)847-8757 <br /> FAX (209) 847-7744 RECORD OF PH. # <br /> CLIENT I CONSULTANT: Lt:S-TLk-T �r�' P.O. #I INVOICE # <br /> 6 <br /> l } ANALYSIS REQUESTED SITE SAMPLE MAI' <br /> PROJECT l SITE NAME: � �"�'` 1 (ITEMIZED AND CRECREO AFLOW) MORT11 <br /> C/) U) <br /> Lu he <br /> cc <br /> STREET: �— re q/ CITY: �`fT 1� STATE: I o �a c <br /> 2 0- <br /> CD CD 6 <br /> G L,, Q cr O O W w <br /> W J <br /> co <br /> TO 1 ��11T HIP VIA: r v J� dco = W m <br /> WAYBILL a = " m <br /> SAM E (PRINTED SIGNATURE) u�S Q <br /> -J N W Q U <br /> CJ O F w GAO C3 CL cr <br /> OAC W m- to <br /> SAMPLF. LOCATION DATE TIME NUMBER TTPF. GAPLE o [c0-Cl ,� o J <br /> (IDENTIFICATION) MTSJDAI%f R. ROURlMIN. OF {GRARORRIX ~ N F— REhIARKS/* SPECIAL INSTRUCI7UNS BELOW <br /> C'ONTAlNERS COMPOSITE) >— H � m cd co 04 1-- <br /> 3.) <br /> 4) <br /> 5.) J?AA � <br /> 6.) <br /> 7.) <br /> 9.) <br /> Ilk) <br /> rJ +•S.4AjrPz IWF.GRUI-I CONDITION 6 TURT'AROUNn TI�IF. •- <br /> Ko i <br /> DATE RECEIVED ATE/TIE: <br /> RINQ ISHEDBY: lPRESERl'AT1V0911SED }"1~\-`vv-S NO <br /> CUSTODY SEALS INTACT I YF.-, N[[ MIA bq <br /> AIR RURBI,F.S IN V.O.A.'S I YFS ' Nn '�i LINE M <br /> RELINQUISHED BY:VIIIMTvrn )ATE I TIME: RECEWFII BY:,S1.N— r.. ATF:!TIME: <br /> TURAAROUND TIAlE: CIIEC'F OHF. <br /> Nk{ <br /> RELFNQL'ISHF7!B}': <br /> )ATFtlE: ECEIYED IIT I..4BORATORl':,Hort nxx.xouHr nxE. )ATE I TIME: 'J-FIOUR 0" 11MIRIL 5-,jJNT--N4'P)"PAY <br /> air.H.rrxn <br /> NOTE: LABORATORY SAMPLE ARCHIVING WILL BE 30 DAPS FROM THE DATE SAMPLE WAS COLLECTED,UNLESS OTHER ARRAINGEMENTS ARE MADE <br /> PLEASE RETURT PEL TECH'S ICE CHEST AND BLUE ICE AS SOOI\ A5 POS5IBLE. THANK YOU DEL-TECH FORM C.O.C. <br /> Pink - Field Copy / While & Yelk)w - To Laboralory with Samples / Yellow - Relurn to Client with Results <br />