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0 SAMPLE CHAIN OAUSTODY RECORD <br /> DEL-TECH GEOTECHNICAL SUPPORT (PLEASE PRINT) Lab. Analysis by : <br /> 10624 OLIVE AVE. OAKDALE, CALIFORNIA 95351 LAB MOICE TO : DEIM� ;err <br /> OFFICE (209) 847-8757 tt 0- 6LIvE Ore. <br /> FAX (209) 847-7744 RECORD 1 OF PH.# LdM '21-7 <br /> CLIENT / CONSULTANT: TE >, AE P.O.# INVOICE# <br /> j. ER-L"�f , I '� ANALYSIS REQUESTED SITE SAMPLE MAP <br /> mor ro�c�ui <br /> PROJECT/SITE NAME (ITEMIZED AND CEECIGED BELOW) (NORTH <br /> 't W <br /> rj 4� t1� ? a N L L. Q <br /> STREET CITY STATE o U <br /> _ � 4 <br /> o o¢ w p J M <br /> aSAM (PkINTEO <br /> cia < m¢SIGNA !TURF)- AYBILL o 0 CD <br /> w co O o <br /> a a �c w <br /> W <br /> w g <br /> NUMBER TYPE ca o = x o o a v <br />� SAMPLE LOCATION DATE TIME or (cRAa oR ��� = z V-I � � v ti <br /> (IDalrrIxrc(riaN) M7zrJnArlfZ aouR/Mrx � � MATRIX m m coo co REMARKS I* SPECIAL INSTRUCTIONS BELOW <br /> 2) D <br /> 3) ywo — o'>' <br /> 5) p <br /> 7) <br /> Z <br /> 9) <br /> 10) 2.L, � � �. v <br /> SAMPLE 1NTEGRITI/CONDITION hTVRNAROUAFDTIME *i <br /> X11 RECEIVED COLD&INTACT 1 YE% NO <br /> r <br /> REL <br /> IN UI ED BY ow n ATEI TIM&1�� RECEIVED B] DATE I TIME. PRESERVATIVES USED �YES NO <br /> CUSTODY SEALS INTACT-I YES NO ( y ? A <br /> AIR BUBBLES IN V O.A'S ! YES i � NO ( LINE R <br /> INQUISHED BY mmTmz, ATE I TIME RECEI]ED BI q�cn+r,naE� ATEI TIME <br /> y1 i f I TURN AROUNATIME CHECA ONE <br /> ELINQ4ISIIFI3 B] 6k 14rl�kEi ATEI TIMF ECE f F_U BI' R� �} �reorEnrrnrouv,n+r[� ATE!TIME -� IIUI.R <B FIOUR S DA] ) 10 DA1 <br /> -o I j <br /> NOTE LABORATORY SAMPLE ARCHIVING WILL BE 30 DAYS FROM THE DATE SANTPLE WAS COLLECTED,UNLESS OTHER ARRAINGEMEN-rS 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 /> -- � 1 ,. T , , , .. r r v.n„ <br />