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C I SAMPLE CHAIN OI ::USTODY RECORD <br /> DEL-TECH GEOTECHNICAL SUPPORT (PLEASE PRINT) Lab. Analysis by : F& L <br /> 10624 OLIVE AVE. OAKDALE, CALIFORNIA 95361 LAB. INVOICE TO :VWA� <br /> OFFICE (209)847-8757 `` l.`il3 �ctrml$ �S3Ar1C3 ��p j,) ► <br /> FAX (209) 847-7744 RECORD 1 OF Pu.* &J6114 <br /> CLIENT / CONSULTANT: -f PK S-5�, P.O.# INVOICE# <br /> v V14 AXZ ANALYSIS REQUESTED SITE SAMPLE MAP <br /> PROJECT I SITE NAME: 11r�1� a (ITEMIZED AND CHECKED BELOW) 4'TT°"""' b <br /> (NORTH <br /> U3 - <br /> U ' <br /> y ` a �O U Z cc <br /> STREET: 4�� � CITY: ��Q STATE: �i o 4 l� <br /> `� o C) <br /> LO Um LU o ._ v <br /> � HIP VIA: 1 m c= a Wco <br /> AYBILL# .t = — N W a <br /> SAM R:�(PRWrR)DLS'1GNATUW g N ti= o <br /> Uj <br /> TOA <br /> SAMPLE LOCATION DATE TIME NUMBER TI'PE MP = s X o Q �X � �' <br /> LE <br /> _ J - - -'-- --- --- _-- - --- - -- - <br /> ' {maxrrFxcr<Tro1v} AfTHJDAI'/YR $OUR/MlN. aDN7xI R5 apAfPOSRE l MATRIX F_ F m m OD H REMARKS/* SPECIAL INSTRUCTIONS BELOW <br /> cc <br /> I.) �'�'� -� tD Ta <br /> z.) <br /> 3.) <br /> 4-)- <br /> 5.) <br /> 6-) <br /> 7.) <br /> 8) <br /> 9.) <br /> 10.) <br /> l <br /> � 1b •;SAMPLE►NTEGRIIT/CONDI TION&TUR NAROUNDTIME •• <br /> . � 96 ` <br /> Lit <br /> 1 RECEIVED COLD&INTACT 1 YES NO <br /> ) ' CU �'�. i a.. <br /> IN UIS BY:aMeu AT$/Tih1E: EC EDB awae�evne, ATE!TIME: ) - PRESERVATIVES USED �•k..L YE,S NO <br /> - y CUSTODY SEALS INTACT I YES NO A <br /> AIR BUBBLES IN V.O.A.'S I YES ( NO LINE 4 <br /> RELINQUISHED BY:cme T r, DATE I TIME: RECEIVED BY: DATE TIME: <br />' 7URN AROUNA T►AfE: CHECK ONF <br /> RELINQUISHED BY:,sh;:nkc. DATE I TIME: �ECEITED BY LABORATORY: DATEI TIME: -HUUR { 49-HOUR ( 5.DAYY} 10-DAY ( ' <br /> -NOTE: LABORATORY SAMPLE ARCHIVING WILL BE 30 DAYS FROM THE DATE SAMPLE VAS.COLLECTED,UNLESS OTHER ARRAINGEMET"IS 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 />