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SAMPLE CHAIN OIKUSTODY RECORD <br /> EL-TECH GEOTECHNICAL SUPPORT (PLEASE;PRINT) Lab. Analysis by <br /> 10624 OLIVE AVE. OAKDALE, CALIFORNIA 95361 LAB. INVOICE TO : lurc�TEZIA_ ffi <br /> OFFICE (209) 847-8757. <br /> FAX (209) 847-7744 RECORD OF PH. # <br /> CLIENT 1 CONSULTANT: \IAL� <� S T 1 P.O.# INVOICE# <br /> I/VAS''" ANALYSIS REQUESTED SITE SAMPLE MAP <br /> PROJECT/SITE NAME: (ITEMIZED AND CHECKED BEIDW) <br /> (NORTH <br /> STREET. CIT+: �'P�1"1 V STATE: � o ag a � cr <br /> • <br /> i.MN- 1116 <br /> Ll �` �n �o � o <br /> HIP VIA: a, � c ¢ J a <br /> cn <br /> SAMPLER:(PRINrEv Sx;NATURE) AYBILL# ¢2 N w CO U <br /> $ 33 M c (D <br /> cd .92 W co `� ¢ <br /> ~O 4 d x LJ.f <br /> NUMBER TYPE ca a s< o wY\'f <br /> SAMPLE LOCATION DATE TIME SAMPLE o o r> <br /> (IDENnFiG1TION) MT .Y/17- 80UR/MIN. OF {cRAB ox MATRIX a- a Ira ~ � N N H <br /> caoxTAINERs aoMrosrrs) I— m co CO CO REMARKS/ SPECIAL INSTRUCTIONS BELOW <br /> I <br /> 4.) 3 113 `�. <br /> 5) htiw. _ f6 �Z <br /> a) g� Z. <br /> 9-) <br />� 1 <br /> 'f•MMPI.EINTEGRITY/CONDITION&TURNAROUND TIME ss <br /> RECEIVED COLD&INTACT I YES, NO � } <br /> TFSHED BY::rsr t[, ATE I TIME 1� <br /> RECEIVED Bl':utr.utunt, ATE!TIME PRESERVATIVES USEDVor S'£S NO } <br /> r' <br /> CUSTODY SEALS INTACT I YES i NO NIA <br /> AIR BUBBLES IN V.O#.'S I YES } NO LINE f <br /> 1 QIIISHFD Bl':�crw.rutit, ATE I T RECEIVED BY: c,urv.c, ATE!TIME <br /> �� G �/ TURN AROUND TIME: CHECK ONE <br /> INQUISBED BY:.cx:.ur��.c ATEI TIM1TE:/U/la F.CEII'F.0 H}'L4130RATOR}':,korrnKx,�o�mr,.,e. ATEI TIME: (� (� '-t-]roux ( <ri•]wi!R ( ) :.DAY w DAI• <br /> NOTE: LABORATORY SAMPLE ARCHIVING WILL BE 30 DAYS FROM THE DATE SAMPLE WAS COLLECTED,UNLESS OTHER ARRAINGEMENIS ARE MADE. <br /> i PLEASE RETURN DEL-TECH'S ICE CHEST AND SLUE ICE AS SOON 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 />