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_SAMPLE CHAIN_ OJ&USTODY RECORD_ <br /> DEL-TECH GEOTECHNICAL SUPPORT -tPLEASE PRINT) Lab. Analysis by : r <br /> 10624 OLIVE AVE. OAKDALE, CALIFORNIA 95361 LAB. INVOICE TO :_VA071 �. . <br /> OFFICE (209) 847-8757 <br /> FAX (209) 847-7744r RECORD _�OF •PH.# <br /> CLIENT I CONSULTANT: +r p6saz,, P.O.#I INVOICE# - <br /> C <br /> Z ANALYSIS REQUESTED SITE SAMPLE MAP LL <br /> PROJ'EGT I SITE NAME: r rrEMIZED AND csr:cxED BELOW) (NORTH <br /> ILL <br /> sn uj;mv� �Ly. <br /> �( j' v LL <br /> O _V z oc - <br /> STREET: � � 31 ! CITY: �1� STATE:�'f� oCC <br /> \'?I� <br /> o <br /> CD <br /> m l['l O W Q J <br /> HIP VIA: d m' A: Q J a ` <br /> 5 o z m F <br /> SAM :tPRBYT®slcr+AivR» AYBILL i n u�l cli <br /> C, �' a s a <br /> J J /� <br /> (� C <br /> SAMPLE LOCATION DATE TIME NUMBER TYPE SglylpLE L' aCL <br /> x c o c ca <br /> (msXTlFtC4rIONJ tdTEJaAY/Ytt BDURlXIM oF�tc�uaoa�' MATRIX a a Cc o C%I C14 <br /> cnxrAlNaRs�oovroseTs l— 1— 0 m co co co F REMARKS/ AL I UCTIDNS BELOW►— 0 m co ao ao F REMARKS/ AL 7 UCTIDNS BELOW <br /> L) 3 L I ID <br /> 2-, m- 3 <br /> 3.) AAA>." TTS bZ <br /> 6) 1bZq `Z <br /> �Y b <br /> 9) <br /> 1 ) <br /> L ;'C�.+►�L .,{f1/t' ttfl <br /> / I�7V!17 <br /> �� '+SAAlPLE INMCR fV 1 OONDfT[ON&TURNAROUND TIME rs <br /> - dor/ RECEIVED COLD h INTACT• ! YES NO <br /> I51tFb BY: fu AFB!TIM7r EIVEII BY:mcwnsri /70 <br /> ATEl.TIME: PRESERVATIVES USEYESYES NO = } <br /> CUSTODY SEALS INIAC I—YES i NO ) A <br /> AIR BUBBLES IN V.OA.'S I YES NO X NE/ <br /> INOUISKED BY:4-Km !T[ME: �RE�CEIVFDB�V,- ATE/TIME: <br /> 77 1,t7 n7 �n ,� �� n�� okw h 71 TURN AROUND TIME: CHECKONF. <br /> IN[jC95HED 81':aM:nan,u ATE!TIAtF.J70 F-CEIVF.D BI'L 4BORA-TO)Z).-OTT Tt*+k-c Te-f ATE/TIME:U S.t.HOURjL_j48-FIOUR } DAY 10•OAl' } <br /> NOT9. LABORATORY SAMPLE ARCHIVING WILL BE 30 DAYS FROM THE DATE SAMPLE WAS COLLECTED,UNLESS OTHER ARRAINGEMEN"I'S ARE N'IADE. <br /> PLEASE RETURN DEL-TECH'S ICE CHEST AND BLUE ICE AS SOOT!AS POSSIBLE. THANK YOU DEL-TECH FORM C.O.C. <br /> Pink - Field Copy / White & Yellow - To Laboratory with Samples I Yellow - Return to Client with Results <br />