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*I fad y SAMPLE CHAIN USTODY RECORD <br /> L-TECHGEOTECHNICAL SUPPORT {PLEA E PRIM) Lab. Analysis by <br /> 10624 OLIVE AVE. OAKDALE, CALIFORNIA 95361 LAB. INVOICE TO : De 1 _tec! <br /> OFFICE (209) 847-8757 <br /> FAX (209) 847-7744 RECORD _j _OF_L PH.# {20j) Rq7_- 057 <br /> CLIENT / CONSULTANT: 9,.L A t c( f Assoc(Ales P.O.#/INVOICE# <br /> ANALYSIS REQUESTED SITE SAMPLE MAP <br /> PROJECT/SITE NAME: V,411#1 r MKIZED AND CBMED BELOW) (NORTH) <br /> & y <br /> �1 W Z <br /> STREET: 1-� W . c,n n f CffY: S}o Kkoli STATE: C,A oL. c <br /> 0 1[7 O W Ra L W 3 <br /> FNU, <br /> IA: ma cc <br /> Qo Yzm4Z~SAM :(elttrltED s GNATORFJ ILL 8 w6W S 8 2 w Q d Lu ERLuposrTil <br /> TYPE L; cc n x cc x = w �' `. <br /> C3 SAMPLE LOCATION GATE TIMES = s a a o <br /> (mExrrFresrroN) MrsmAt7rle rrourr/urA ��� MATRIX 2- F F m m m CO �_ REMARKS/*SPECIAL! O BELOW <br /> 1.) !'Y1tiJ- d ! Zl q 15:7.7 ! GRP►8 IATA 'Vr BL. 5a11 c �,rnl <br /> i.) rA W- <br /> 3•) N W -Z I'2- 7V j5-31 <br /> 4.) w - 1� zi j5,3l la (.ET D WV <br /> s-) Tr 1314A +x zi 4 o Sao S <br /> 7.) <br /> 8a <br /> 9.) <br /> 10.) <br /> SAMPLE INTEGRITI'/CONDITION A TURNAROUND TIME <br /> y.3 y RECEIVED COLD&MACr I YES { NO <br /> NQUISHED DATE/TIM& ECEIVED BV:a:cxanaai DATE;TIME: PRESERVATIVES USED I YES {�} NO <br /> /.2-..?2—9 CUSTODY SEALS INTACT I YES NO { NIA { <br /> AIR BUBBLES IA'Y.011.'S I VES NO } LINER <br /> INQUIISH BY.-p.cwrcnu ATE/TIME:!�50 R E1VED Y:ia:ceaiftwi ATE I TIME: <br /> , tURN�tROUT7l TIME: Cff£CF ONF <br /> /a A.7-9 � UR <br /> Z�LGy 24.IfQUR ( y 48-HO ! 5-DAY ! } 10-DAY ! <br /> R INQUISHED BY:.sK:Mnac ATEI TIAI ECEIi FII RY 0RATO1�� mon 4*4.Kounnn.+n ATF./T1%!E:! � 4 J 4 <br /> DOTE: LABORATORY SAMPLE ARCHIVING WILL BE 30 DAYS FROM THE DATE SAMPLE WAS COLLECTED,UNLESS OTHER ARRAINGEMEN"YS ARE MAD& <br /> PLEASE RETURN DEL-TECHS ICE CHEST AND BLUE ICE AS SOON AS POSSIBLE. THANK YOU DEL-TECH FORM C.O.C. <br /> Pink - Field Copy / White & Yellow - To Laboratory with Samples / Yellow - Return to Client with Results <br />