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�. SAMPLE CHAIN CUSTODY RECORD <br /> DEL-TECH GEOTECHNICAL SUPPORT (PLEASE PRINT) Lab. Analysis by : f(�= �-- <br /> 10624 OLIVE AVE. OAKDALE, CALIFORNIA 95361 LAB. INVOICE TO : P1'L1EL- <br /> OFFICE (209) 847-8757 y 13 �6rmlti R- <br /> FAX (209) 847-7744 RECORD 1 OF PH.# <br /> CLIENT / CONSULTANT: S P.O.#I INVOICE # <br />,) PROJECT/SITE NAME: �� 3��- ANALYSIS REQUESTED SITE SAMPLE MAP <br /> (ITEMIZED AND CHECKED BELOW) War Ta SCAU, <br /> *"-3 (NORTH <br /> STREET: MT� CITYs �`�F.�� -: k <br /> STATE: <br /> i 1[TR' { JJHIP VIA: <br /> I SAMPLER:{PRNATURE) WAYBILL# Q <br />�� NUbfBER TYPE � <br /> SAMPLE-LOCATION DATE TIME <br /> (IDENTIFICATION) MTH✓DAk%2'R. HOUR I MIN. QONTAINERS QOMPpSITE) AfATRfX REAIARKS I*SPECIAL INSTRUCTIONS BELOW <br /> 1') YYWJ l 3 6r U 7 <br /> 4) <br /> 5.) <br /> 6-) _. <br /> 7.) <br /> 8.) <br /> 9.) <br /> 10.) <br /> 3 " / <br /> 1 SAhIPl6lA'TEGRITI'1 CONDITIOA' TtIRAAROL'ND T16fE •• <br /> RECEIVED COLD s INTACT I vF_s NO <br /> RELiNLILzL 6]':su:naTn ATE!TIME: RECEIVED, !EE_ F ( NO ) <br /> CUSTODY SEALS INTACT I ]'ES { } NO ) NIA <br /> AIR SUBBMS IN V.O.A.'S I YFC } NO LINE R <br /> RELINQUISHED 8Y:swv rvRn ATE/TIME: RECEIVED BY:swhaTUPE, ATEI TIME: <br /> TtRNAROUNDTIAIE: CUEC'A'ONF. <br /> RELINQUISHED BY:Ruaanu.F. DATE/TINIF: F.CEIVED BY ATF-/TIME: 24.DOUR 48•HOUR S-DAY { } 10-DAY <br /> NOTE: LABORATORY SAMPLE ARCHIVING WILL BE 30 DAYS FROM THE DATE SAMPLE WAS COLLECTED, UNLESS OTHER ARRAINGEMENTS ARE NIADF;. <br /> PLFASE RETURN DEL.TECH'S ICE CHEST AND BLUE ICF;AS SOON AS POSSIBLE. THANK YOU DEI,-TECH FORM C.O.C. <br /> Pink - Field Copy 1 White & Yellow - To Laboratory with Samples I Yellow - Return to Client with Results <br />