Laserfiche WebLink
SAMPLE CHAINUSTODY RECORD <br /> DEL-TECH GEOTECHNICAL SUPPORT (PLEASE PRINT) Lab. Analysis by : Cs <br /> 10624 OLIVE AVE. OAKDAM CALIFORNIA 95361 LAB. INVOICE TO &A&� WWdLc * ; 00 <br /> OFFICE (209)847-8757 p " + <br /> FAX (209) 847-7744 RECORD_LOF PH.#,.739 ) ��'��} _ <br /> CLIENT/ CONSULTANT: P.O.#/INVOICE# <br /> I SITE NAME � j t�,r`'� MdY1 rt�I� YW l V% ANALYSIS REQUESTED �FY SITE SAMPLE MAP <br /> PROJECT <br /> � (ITEMIZED AND c9ECId5b BELOW) � (NORTH) <br /> C, = N y <br /> STREET- 1 T b 1 LJ• (9fTr a' T CITY: �CXgj*iTCA STATE t$� L'j Ir <br /> L9CD U1j 2;fr fn CD T4110 o <br /> CC <br /> A- <br /> --j <br /> 64T- IiIP VIA: � �� c z m rn <br /> SAMPLER (P SIGNATUIM AYBELL a N w a v <br /> 0 0o m j w <br /> SAMPLE LOCATION DATE TIME NUMBER TYPE SAMPLE r� o ' �, x CL W <br /> (MIF) 7FlCATION) .�TBJD.tY/SZ BOUR/AfIN OF (GRAS OR MATRIX 0- c:) <br /> N N IJ– <br /> t aoxrAlnrERs cvAmosfas) 1- m CO co co F- REMARKS/ S�P-E�CIAL INSTRUCTIONS BELOW <br /> 3) 01 <br /> 111 1 <br /> 4) Y*A4 -- 111 $ Z <br /> 5) <br /> 6.) h%w' 2 <br /> s) <br /> 9) <br /> 1 ) <br /> } SAMPLE fN18CRlTI/CONDITION A TURNAROUND TIME �+ <br /> RECEIVED COLD&INTACT ��1 YI5 NO <br /> � i <br /> RE, NQ ISHED BY ui ATE 7 TIME. HVED 8Y aweunme� ATE/TIME. !� PRESERVATIVES USED 1 ES NO ) <br /> CUSTODY SEALS INTACT r YEs } NO ( ' NIA bd <br /> AIR BURBLES IN V OA S r YES ( ) No IXy LINE#—.- <br /> RELINQUISHED BY Q�c1unnu ATE!TIME ECEI\'ED BS �s�cwnxq ATH J TIME �v <br /> TURN AROUND TIME CSECAONE / <br /> // <br /> RELINQLISHED ON ar Mnau ATE TI61IF_ �EC'EIVEDRYLABORATORY nonnn.n.raaron ATE/TIME. '-i IIOUR 48 HOUR > DA) j'l) i6 DAl { } <br /> NOTE LABORATORY SAMPLE ARCHIVING WILL BE 30 DAYS FROM THE DATE SAMPLE WAS COLLECTED,UNLESS OTHER ARRAINGEMEI\'1'S 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 1 White & Yellow - To Laboratory with Samples / Yellow - Return to Client with Results <br />