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0 SAMPLE CHAIN O CUSTODY RECORD 4S DEL-TECH GEOTECHNICAL SUPPORT (PLEASE PRINT) Lab. Analysis by <br /> 10624 OLIVE AVE. OAKDALE, CALIFORNIA 95361 LAR INV ICE TO <br /> OFFICE (209) 847-8757 b Z 6LN <br /> FAX (209) 847-7744 ;} RECORD OF PH.# ( 1&71217 <br /> CLIENT / CONSULTANT: t�+omq,,�'ti-TtrN w. I ffms P.O.#1 INVOICE# <br /> QAAAIQC�t..I &iWt &T SITE SAMPLE MAP <br /> ANALYSIS REQUESTED <br /> PROJECT/SITE NAME ITM1W&_ (1TEMIZEDAND CBECXEDBELOW j i puTw■cAM (NORTH) <br /> y�l�� S*Pfo f► a -,m U Q <br /> STREET tJ v CITYR6" STATE `,�.) o °C <br /> m LU <br /> 11 <br /> { HIP VIA �-Tm� --jS z m <br /> SAMPLER (PRINTED sICNATuRE) AYBILL# � N w V a <br /> O <br /> V. <br /> � a w <br /> ¢ w 3-- w g <br /> SAMPLE LOCATION DATE TIME NUMBER TYPE SAMPLE t9 v = ,r, x v � o J <br /> 2 z an <br /> (10EAFVF1G4T10N) MM.ODAY/17Z BOAR/MIN CONTAINERS C�MPOSTIE) MATRIX a m cNo W REMARKS/* SPECIAL INSTRUCTIONS BELOW <br /> 3)WAA)- 3 <br /> 4) <br /> 6.) <br /> 7) <br /> 8) <br /> 9) <br /> 10 <br /> 1 + 5 L *+SAMPLE INTECRITI/CONDITION A TVRNARiOVND TIME <br /> i v RECEIVED COLD&INTACT 1 YES NO <br /> � ` J <br /> WNQTSHEID BY NA ■Eo ATE I TIME RECEIVED 82 swwAnn,c, ATE 1 TIME. PRESERVATIVES USED)VYES NO } <br /> CUSTODY SEALS INTACT I YES i NO l( A <br /> AIR BUBBLES INV OA / YES ( NO LINE 0 <br /> RELINQUISHED RA E,c uT,mc ATE I TIME RECEIVED Bl IsiGmTm2, ATE 1 TIME <br /> � �\,]/�� LoTURNARRVNAT1rH$ CHECRONE <br /> RELINQLI4IIED 8) nn vttI.Ei ATE TINIF EC� BY LABORATORI ��oT'E�Kou-mT,NATE/TIMffE i HUL�R ( IS HOUR S VAI { 10 DA) <br /> �j] <br /> NOTE LABORATORY SAMPLE ARCHIVING WILL BE 30 DAYS FROM THE DATE SAMPLE WAS COLLECTED,UNLESS OTHER ARRAINGEMENTS ARE MADE. <br /> PLEASE RETURN DEL-TECH'S ICE CHEST AND BLUE ICE AS SOON AS POSSIBLE THANK YOU DEL-TECH FORM CO C. <br />