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0 0 SAMPLE CHAIN O�USTODY RECORD * I <br /> 4SDEL-TECH GEOTECHNICAL SUPPORT (PLEASE PRINT) Lab. Analysis by 'r" <br /> 10624 OLIVE AVE OAKDALE, CALIFORNIA 45361 LAB INVOICE TO <br /> OFFICE (209) 847-8757 [ i` y iw c 1 e n- <br /> FAX (209) 847-7744 RECORD �OF PH # { P ) `;�"d-- '1,7£Lf <br /> CLIENT 1 CONSULTANT: CA P.O # INVOICE# <br /> ANALYSIS REQUESTED SITE SAMPLE MAP <br /> PROJECT I SITE NAME1(i "'1 (ITEMIZED AND CHECKED BELOW) ;� lx I <br /> <� cc <br /> o cn <br /> STREET C ) CITY 1� �`1 STATE +�' o L�2 Lu a < )` <br /> >o cc <br /> t� m CD Lr) OLu Lu <br /> 0 Q Q O J uwr <br /> 1 L��1 L HIP VIA a, m e ¢ J a � ✓� <br /> EMPLER1,, :DISICNATqM� AY$ILL# = o w ¢ _j <br /> `� cc cc � v <br /> 4T O1 J H <br /> O 0 LJJ 2 t1 W uj <br /> NUMBER TYPE c� o m L X o 0 o v <br /> SAMPLE LOCATION DATE TIME aF (cRABoR SAhfPLE z n_v v 1_ � 4 <br /> (IDENTIFICATION) MTHJTM}IYR HODRrMTx ovNTwtxBxs mMPOSITs) Mr4TRIX m allo R1';KSI* SACIAL IMITRUCTIONS BELOW <br /> z) —� -� S CK S-ATE <br /> 4) <br /> 5, ) _ y � <br /> 6-> <br /> 7, M LAJ- <br /> 9, r- <br /> lo, - L lC((n <br /> q I / f r�t�"� ••SAh1PU INTEGRITI I CONDITION A TURNAROUND TIME <br /> ( 1 r <br /> r J <br /> F A#�j '� ✓ �f rd J� RECEIVED COLD&INTACT I N R, � �{ *a <br /> L Q [SHED BY uIC ac. ATE/TI &'^^ ECE[V ED 07 iSICiUT[IRF, ATE I TIME PRESEM ATIV ES USED f ' -l )ES J/I NO <br /> CUSTODI SEALS INTACT1 YE.c ( NO NA <br /> AIR RUBBLES 1N V OA S 1 YES NO LINE N <br /> LTNQU1SHED 111 FrruTurF, ATE I TIME REC EIV ED H1 6IC"TUM DATE 1 TIME <br /> TURA AROUND TIME CHECA ONF !! <br /> RLI1NQLiStlt•9 B1 al,%FnaIF ATEI TI%IF �ECEXED RI L480RATORI iM Tt TLKNAWM)TIMf ATF I TLNIF U 1[Ut�R 48 HOUR VA) Vf 10 DAI } <br /> ROTE LABORATORY SAMPLE ARCHIVING WILL BE 30 DAYS FROM THE DATE SAMPLE WAS COLLECTED,(- LESS OTHER ARRAINGENIENTS ARE MADE 7 <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 1 White & Yellow - To Laboratory with Sampleti 1 Yellow - Return to Client with Rmlt% <br />