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SAMPLE CHAIN WUSTODY_RECORD <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 t a L _i2t <br /> FAX (209) 847-7744 RECORD 1 OF PH.# ()k5 <br /> CLIENT/ CONSULTANT: -� �5 � P.O.#/INVOiCE# <br /> ANALYSIS REQUESTED SITE SAMPLE MAP <br /> PROJECT/SITE NAME: ktLL 111+ ( (ITEMIZED AND CHECxED DEIOw) d ,W SCAM <br /> (NORTH <br /> V � <br /> y� w I/3 <br /> STREET: 1 CITY: CTari STATE: �A J a 3 <br /> $ LO �o w o J N u <br /> HIP VIA: ~ -, m <br /> cr <br /> SAMPLER:(PRmrED I;. [i t'WTWAYBILL#De ¢2 o "' < <br /> (43 � oJ � _ a <br /> a CL - c` <br /> NUMBER TYPE 0 C3 x o 0 0 <br /> SAMPLE LOCATION DATE TIME ► = = 0.a <br /> (IDENTIFICATION) MTITJDAYn7L SOUR/MIN. OF . (CRAB OR MATRIX a- d m o ccv c~1I * , <br /> CONTAINERS aoMrosn-E) i- I— m ao E ap F REMARKS./ SPECIALINSS�TRUCTIONS BELOW <br /> Ia bU $ = LAR- c <br /> Z.) Z, <br /> 3.) l� t <br /> c <br /> 4.) — t Z {L <br /> 5.) rJ <br /> &) <br /> 7.) <br /> 9.) <br /> I0. <br /> "SAMPLE INTEGRITY/CONDITIONd:TURN.4ROUNOTIME •• <br /> r "✓S _� RECEIVED COLD a INTACT I YES (r } NO <br /> ISHED BY:e A E. DATE/TIME_\1J9��� ECE(YEDB_V_41C� E, ATE!TIME PRESERVATIVES US&D 1+tL 5'ES NO <br /> C"I1STODV SEALS INTACT 1 YES' l ' NO NIA ) <br /> ��1��� - AIR BUBBLES IN V_OA'S I YES NO � LINE I <br /> INQUISSEI}BY:Eicw�iupuDATE TIME: ECEIVED_Bl':'S1G—__ ukc' DATE/TIME: <br /> TURN AROUND TIME: CUECA OXF <br /> r <br /> FJF1YQl:ILBP.U�61': 24.IIOLR } 4S-HOUR } 5 DAS' 10-UAL' <br /> a-:Mn-E. ATE!TIME: I}/± }' IjQJ(.'}?'OJlI':.korE na:k.kouv,nxE. ATE l TIME: I� <br /> NOTE: LABORATORY SAMPLE ARCHIVING WILL BE 30 DAYS FROM THE DATE SAMPLE WAS COLLECTED,UNLESS OTHER ARRAINGEI4EN TS ARE MADE. <br /> PLEASE RETURN DEL-TECH'S ICE CHEST AND BLUE ICE A5 SOON AS POSSIBLE. ',THANK YOU DEL-TECH FORM C.Q.C. <br /> rs.. <br /> Pink - Field Copy 1 White & Yellow - To Laboratory with Samples 1 Yellow - Return to Client with Resolts <br />