Laserfiche WebLink
SAMPLE CHAIN 00CUSTODY RECORD <br /> #EL-TECHGEOTFCHNICAL SUPPORT (PLEASE PRINT) Lab. Analysis by <br /> 10624 OLIVE AVE. OAKDALE, CALIFORNIA 95361 LAB. INVOICE TO : P151,T6U'�- <br /> OFFICE (209) 847-8751. <br /> FAX (209) 847»7744 RECORD �_OF PHT <br /> .# � ) 7877 YZ _ <br /> CLIENT / CONSULTANT: 4-A5�ff_I, P.O.#1 INVOICE# <br /> Q SITE SAMPLE MAP <br /> ANALYSIS RE UESTED <br /> PROJECT/SITE NAME: ��`���'�'�� <br /> &A, <br /> ��'�,� f ITEMIZED AND CHECKED BELOW) jNOf 7"` <br /> (NORTH <br /> Wz <br /> C) U Z <br /> STREET: CITY: �� `�V STATE: � CD a a� <br /> t x CD (D cc <br /> W <br /> > It <br /> 0 L7�C1 LUQ W W <br /> HIP VIA: G o c i o z m }a � �/ <br /> SAM R (e[t[tvr®s[ctvATaR� <br /> WAYBILL# — n, "' a 't <br /> 'If <br /> co �, o 00 8 � � a �� <br /> CD o �o `r a a U • <br /> Ir w cu 2 <br /> SAMPLE LOCATION DATE TIME <br /> NUMBER TYPE CD o z�., x o 0 o U <br /> OF <br /> (GRAS Ore z = ci a r �- v <br /> (IDSA7TFICATION) Af'TIVAM /Yl[ HOUR/Al1N. � � mArrns�rs� MATRIX m REMARKS/*SPECIAL INSTRUCTIONS BELOW <br /> I-) - 001� blATip— y' <br /> Z•) <br /> 4.) I-3 Z <br /> 5.) Cwv- Pof> 31- <br /> 6.) t%1' �- -73 b Z <br /> 7.) <br /> 9.) 1 <br /> I <br /> -�, V17 SAMPLE INTEGRITY/CONDITION&TURNAROUND TIME •• <br /> , . <br /> /7/� RECEIVED COLD d INTACT ! 5'F.S� NO ( <br /> N ISHED BY: ae, ATE!TIME: E1VED BY:es�c..eua., ATEI TIME: PRESERVATIVES USED ! 'L' YES KNO <br /> CUSTODY SEALS INTACT I YES NO 'A <br /> AIR BUBBLES IN V.OA.'S 1 YES ( No [r,/�ffJ LINE N <br /> INQUISHED BY:ow.w TDATE TIME: RECEIVE .w.mTuR[. DATE/TIME: <br /> TURNAROUA'OTIME: CHECKO,VF <br /> I Tl M !0- <br /> 2 <br /> - <br /> / . '" � S'bZ) J-f[UL!R 68-HOCIR { } �•DAl' LA 1' <br /> RE':QCISIII'D BS':�N:n.n�u ATE/TIME: c�fjQCE/ti 1! Iij LABURATORYu <br /> : r n•ku.raro ri+�E� ATF, v <br /> NOTE: LABORATORY SAMPLE ARCHIVING WILL BE 30 DAYS FROM THE DATE SAMPLE WAS COLLECTED,UNLESS OTHER ARRAIS'GEMENTS ARE MADE <br /> PLEASE RETURN DEL-TECH'S ICE CHEST AND BLUE ICE AS SOON AS POSSIBLE. THANK YOU DEL-TECH FORM C.O.C. <br /> Pink - Field Copy I White & Yellow - To Laboratory with Sampies I Yellow - Return to Client with Results <br />