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SAMPLE CHAIN O USTODY RECORD <br /> DEL-TECH GEOTECHNICAL SUPPORT (PLEASE PRINT) Lab. Analysis by . _ �b L <br /> 10624 OLIVE AVE OAKDALE, CALIFORNIA 95361 LAB INVOICE TO PeA DI 62zlig-L <br /> OFFICE (209) 847-8757 --0-13 $ 101J <br /> FAX (209) 847-7744 RECORD OF PH # ( ) 9 q bd 7 <br /> CLIENT / CONSULTANT: X41 1• 1 '1TZ. S sem, P.O #I INVOICE# <br /> t �� tdCA <br /> ANALYSIS REQUESTED SITE SAMPLE MAP <br /> PROJECT I SITE NAME �M�Z 5*-)J # � (rTEMr7ED AND CBECAZD BELOW) "°r`°SCAM a <br /> (NORTH) <br /> Uj fn <br /> r <br /> En <br /> U � <br /> STREET L.�w'' 'F CITY r I� STA0 4a a � +'! <br /> ;� CD p <br /> 92 cc <br /> }} a�Yp CD Q <br /> LU <br /> IF7YB <br /> IA 1Q, x a J aILL# fR•(PRARffi 61CNATURiQr o w <br /> SAMPLE LOCATION DATE TIME NU'►iBER 'E _ a x o o c r <br /> of t GRAB oR v r� � <br /> (1D$NTPPtCATroN) MTHJDAYIYR HOUR/AlIN � � m co co W REMARKS/* SPECIAL INSTRUCTIONS BELO l <br /> ra To Pti� <br /> z) <br /> 3) <br /> l <br /> 4) <br /> I S) <br /> 6) <br /> x 7) <br /> 8} <br />� 91 <br /> l0} <br /> • � '� �� 1 1j ++SAMPLE INTEGRIT7/CONDITrON d TURNAROUND TIME •s <br /> r' RECEIVED COLD&INTACT I YES NO 4 <br /> RELIN fS BYaww ATEITIME EDBtiwcn,�nn�c, ATEITIME. I( ;�o PRESERVATIVES USED LYES NO <br /> CUSTODI SEALS INTACT 1 Y&S ] No ( } A <br /> AIR BUBBLES IN V O.A'S f YES No L"E N <br /> RELINQUISHED BY isxa nu ATE f TIME RELEIN ED BS DATE I TIME <br /> TURN AROUND TIME CHECK ONE <br /> RELINQLII;lIEDB't ap—im , �DATEO TIME ECEATD BI'LABORATOR I' ,wonnwn.. ,—tDATE/TIME. 24 HOUR ( ) 48 xoUR DAl/10 DAl <br /> NOTE LABORATORY SAMPLE ARCHIVING WILL BE 30 DAYS FROM THE DATE SAAiPLE WAS COLLECTED,UNLESS OTHER ARRAINGEMErTS ARE MADE. <br /> PLEASE RETURN DEL-TECH'S ICE CHEST AND BLUE ICE AS SOON AS POSSIBLE THANK YOU DEL-TECH FORM CO C <br /> Pink - Field Copy / White & Yellow - To Laboratory with Samples 1 Yellow - Return to Client with Results <br />