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� r ~ <br /> • SAMPLE CHAIN 01WUSTODY RECORD <br /> DEL-TECH GEOTECHNICAL SUPPORT (PLEASE PRINT) Lab. Analysis by . <br /> 10624 OLIVE AVE. OAKDALE, CALIFORNIA 95-M1 LAB. INVOICE TO <br /> OFFICE (20} $47-$757 <br /> FAX (209) 847-7744 RECORD OF PH. # <br /> CLIENT / CONSULTANT: P.O.#/INVOICE# <br /> V4 ) _ rV+ ANALYSIS REQUESTED SITE SAMPLE MAP <br /> ME <br /> PROJECT I SITE NA 'S �C� t ITEMIZED AND CRECIXD BELOW) "T TO�� (NOR <br /> cn <br /> _ U h- <br /> STREET CYTY `` 1�iii STATE c °C z 0 <br /> r LU8 Cl W • <br /> HIP VIA ..�.y� °C= P = m cn <br /> SAMPLER RRDmo sIGNATuM WAYBILL# W co <br /> NAT <br /> UMBER TYPE SAMPLE cs x 0- x o 0 c^ a( ' <br /> SAMPLE LOCATION DATE TIME aF cRAa OB z = a r <br /> (ID sxiTtTrAT1oN) erramArmL Lzou>:f urx �h,7,u � ��� MATRIX m m REMARKS/*SPECIAL INSTRUCTIONS BELOW <br /> F%Y1AA_ a- t <br /> 3) <br /> 4) <br /> 5) <br /> 6.) <br /> 7) <br /> 8) <br /> 9) <br /> f to) <br /> b � �� l_;`l— ,1` ••SAMPLE INMORITI/CONDITION A TURNAROUND TIME •_ <br /> RECEIVED COLD do INTACT I YES NO <br /> YSR�BY B nu, ATE I TIME EP YED BI csIcwtvei, AT£I TIME '�' PRESER\'wTIYEs USED�.�I11,&% NO t } <br /> CUSTODY SEALS INTACT I`YES ] NO NIA <br /> AIR BUBBLES IN V O.A 5 / YES } No LITE N <br /> RELINQUISHED Bi DATEITIME EI\ED 61 oiGwTmcp DATEI TIME <br /> TURN AROUND TIME CHECK ONE11R � �( <br /> ELIYQLISHED B} DATE!TIME ECEI{'ED RY LABORATORI' DATFL TIME 'A HOUR ( ) 48 HOUR { � � 0A1 IJ f 10 DAI � } <br /> NOTE LABORATORY SAMPLE ARCHIVING WILL BE 30 DAYS FROM THE DATE SAMPLE WAS COLLECTED,UNLESS OTHER ARRAINGENIEtt'TS 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 / White & Yellow - To Laboratory with Samples / Yellow - Return to Client with Results <br />