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p�'�0-7 05c) 3 SAMPLE CHAIN OF CUSTODY RECORD � � . <br /> DEL-TECH GEOTECHNICAL SUPPORT (PLEASE PRIM') Lab. Analysis by <br /> 10624 OLIVE AVE. OAKDALE, CALIFORNIA 95361 LAB. INVOICE TO :0nL-mj L,L EIJE�2 ], <br /> OFFICE (209) 847-8757 _ y ��, 1°�A wklleE <br /> FAX (209) 847-7744 RECORD _-OF�_ PH.# ( LA <br /> CLIENT I CONSULTANT:' P.O.# INVOICE# <br /> k w 1w. L]gZr btl &g. ANALYSIS REQUESTED SITE SAMPLE MAP <br /> PROJECT !SITE NAME: �` (ITEMIZED AND CHECKED BELOW') ° """ <br /> (NORTH <br /> � N <br /> U <br /> �,,J� J Om U Z G <br /> STREET-1 TTY` IM 1 STATE: VJCt' n Cc CC .le <br /> Y o CD Q TALI <br /> C3 Lo oC, o a w w <br /> I....h v ^ L SHIP VIA: oQo jE� Zn <br /> ¢= Q z m r3 cn <br /> SAM (PRINTED SIGNATURE) AYBILL# a o � `' , <br /> <w w o 2 gd <br /> c� <br /> 00 CR v a a �[ w <br /> Cc LU _ w g <br /> SAMPLE LOCATION DATE TIME NUMBER TIDESAMPLEc%s a z W X o 0 o ca <br /> OF (CRA$OR S = a-CLf- <br /> (MEN"RCATION) AOHJDAVI)R HOURlMfN. �fy=� � CUMPOSITE� MATRIX F m co H REMARKS/ SPECIAL INSTRUCTIONS BELOW ' <br /> 3--)V,19. V yft` 6-lob L <br /> 4.) . <br /> 5.) <br /> 7) . <br /> 8.) <br /> 9.) <br /> 1 ) <br /> S4AIFIR INT£GRf Y1 CDADITION A TURNAROUND TIME •� <br /> v{' / RECEIVED COLD S INTACT I YRS NO <br /> AINUISHED BY:un DATE I TISIL-tV RECEIVED BV:, DATE I T11170� PRF.SERA'ATIV ES USED i "L YES NO <br /> CUSTODY SEALS INTACT I YES NO ' ) NIA Y <br /> AIR BUHeLFS IN V.O,A.'S I YES ) 11'0�01 LINE If <br /> E QUISHED BY:6W.HATMC1 TIME: R dif.WTVk& DATE I TIME: <br /> /3 TURA'AROUA'OTIAIE: Cff£CA"ONF. <br /> 9G [ j��jl_�k,�j, + c to ` 15/0 <br /> RL10Fbr:..naEATE!TI?1 F::�{�� F_CF,I1 FU B l–h RORA TO Y: �V t TEti­ou-T.11. DATF!TME: '-a-HOUR � } 413•HOUR IM 10.DA X <br /> NOTE: LABORATORY SAMPLE ARCHIVING WILL BE 30 DAYS FROM THE DATE SAMPLE WAS COLLECTED,UNLESS OTHER ARRAINGENIENTS ARE\IAD£. <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 />