Laserfiche WebLink
J � <br /> SAMPLE CHAIN 00CUSTODY RECORD <br /> DEL-TECH GEOTECHNICAL SUPPORT r PLEASE PRINT) Lab. Analysis by : <br /> 10624 OLIVE AVE. OAKDALE, CALIFORNIA 95361 LAB. INVOICE TO : <br /> OFFICE (209) 847-8757- <br /> FAX <br /> 47-8757 FAX (209) 847-7744 R CORD J OF �, PH.#_P61 <br /> CLIENT/ CONSULTANT: V,k CJ1P i 1 P.O.#/INVOICE# <br /> W l ' { ANALYSIS REQUESTED SITE SAMPLE MAP <br /> PROJECT lSITE NAME: M 4 ✓ , C.J� rlTEMf7EDAND CHECKED BELOW) ""r"° cr <br /> cr <br /> (NORTHr <br /> W v7 N 7 <br /> Q� Nff <br /> oW v <br /> � STATE: rQ STREET: CITY: 7 ' C <br /> W <br /> LU <br /> b HIP VIA: Cm m ¢x ¢ dp <br /> o Q N { <br /> SAMPLER:(P IGNATURE) AYBILL# �1�`�' y j o LU < a a f` 1r <br /> Cal d OW J c J cc � ` <br /> O Q 0. _ r <br /> lip <br /> NUMBER TYPE trs x 1. �[ o 0 o v <br /> SAMPLE LOCATION DATE TIME SA AI!'I� = = a a <br /> OF (GRAB OR 'R r— 1 <br /> (IDENTIFICATION) ACI9JDArmt AlA 7'RIX � � � m co o o REMARKS/# SPECIAL INSTRUCTIONS BELOW L <br /> �.��11�G1►J� � Z <br /> j 3-> � <br /> 4.) rv-vt ! �r7�0 �l T �A -E o*L L <br /> 5.) h'� - -.I- tib - zz' PLS all Vv�' W IgD l <br /> 6.) T AAA) - y 2 <br /> 7.j" tp <br /> g.} <br /> OOF <br /> I <br /> SAMPLE INTEGRITY/CONDITION&TURNAROUND TIME •• <br /> I. !�'f /� RECEIVED COLD&INTACT / YLS Ir }� NO ( } <br /> N01 HED BY:erxHA w ATE! d ECEIVED BY:awnaru� ATE/TIME ES USED 13 Y1 NO } <br /> CUSTony SEALS iNrAcT / YES NO � } N/A <br /> / AIR BUBRLFS IN V.OA.'S 1 YES,( NO LINE.M <br /> � INQUIIHED DATE/TIME: 81':aicurv. TIM <br /> - / J f� �/ / C TURN AROUND TIME.- CHECK ONF, <br /> R �QUISHED BY:6M:UTIN[i ATE! ['I\IE:/� RECEIVED BI'LAi BORATOR}': N01ETt9 N4xO MTIM[ ATE!TI E ?t•HOUR IR•HOUR { � S•f1A1' V� I6•1JA1' { j <br /> r <br /> NOTE: LABORATORY SAMPLE ARCHIVING WILL BE 30 DAYS FROM THE DATE SANII'LE WAS COLLECTED,UNLESS OTHER ARRAINGEMEN"I'S ARE MADE. <br /> PLEASE RETURN DEL-TECH'S ICE CHEST AND BLUE ICE AS SOON AS POSSIBLE. ]HANK YOU DEL-TECH FORM C.O.C. <br /> Pink - Field Copy / White & Yellow - TO l uoratory with Samples 1 Yellow - Retum to Client with Results <br />