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SAMPLE CHAIN O USTODY RECORD i ''' ' I 11v \ 0 <br /> DEL-TECH GEOTECHNICAL SUPPORT (PLEASE PRINT) Lab. Analysis by ED <br /> 10624 OLIVE AVE OAKDALE, CALIFORNIA 95361 LAB INVOICE TO ' Z4 <br /> OFFICE (209) 847-8757 <br /> FAX (209) 847-7744 RECORD �OF PH # <br /> CLIENT / CONSULTANT: P O.#/INVOICE# <br /> ANALYSIS REQUESTED 1 SITE SAMPLE MAP <br /> PROJECT/SITE NAME � �� ti (r UIZED AND CHECKED BELOW) MT ZCA L& <br /> (NORTH) <br /> f� �Om In U Z cr <br /> ST �� iY'1 CITY STATE �/ ' o w �6 <br /> *a a CD <br /> _ g DE <br /> o <br /> O LLJ <br /> L. 1]¢ Q O _j 4 <br /> 'lNl HIP VIA i(1�1 il�T ,1, m oQo a ¢ ¢ C <br /> SAM (PRBYfED stcNATURE) AYBILL IF G`• �LJrej o w LW <br /> o CDS oac ¢ <br /> 3M Lu <br /> trw� <br /> SAMPLE LOCATION DATE TIME NUMBER TYPEFMPS cry o w x o 0 0 �, <br /> Of (CRAB OR _ �� }— � E, <br /> (IDENTIFICATION) 6fTHJDA171R. SouRrAlrx avNTAJNERS m,KPosrrE� TRIX m w � C REM KS/* SPECIAL INSTRUCTIONS BELOW <br /> �L,3 Lq o iq <br /> Z)VW1 �- <br /> 3) - b 8,�, j A, <br /> 'I) �ftw 6 <br /> Q 1 ^^I-& -I,- <br /> 5) <br /> 5) f DL. <br /> 6-) Vrao <br /> ,) - 4- $. t23,t �L <br /> 10) �� L ' z 2 L, V <br /> 1 j'2+ j "SAMPLE INTEGRM 1 CONDITION d TURNAROUND <br /> i <br /> _{�5 I J % l _ I i r C RECEIVED Col D d INTACT ! S FS � No � } <br /> JISHED BY ar Tvk ATE I TIME.'3 e7ls�( !?D 71aEcw i AATF I T'11ME %3u PRESERA AT[\IS USED ! IES NO i <br /> C'USTOD) SEALS INTA('r ! SEC ( ' NO ( ) NA <br /> �y � AIR BUBBLES IN N O q c ! VES ( � N[1 i } 1 INF N <br /> RELINQUISHED BI fW-TUkL ATEI TIME. EC l��L B7 cftl'V T / ATEI TII61h <br /> TURN AROUND TIME CHECAOAT <br /> tL4 `'t <br /> �^ VOTE T1.1a 1—TLMF -i HOI k 4A IIOtIR ! ` DA I 10 DA} l <br /> RFI lVQLlSHFD Bl 6N\�TlkEi ATEI TIAIF 1;tC� � �ll.. BU ATF I T['(1�IC -' � ` � 1 / <br /> NOTE LABORATORY SAMPLE ARCHIVING WILL BE 30 DAYS FROM THE DATE SAMPLI 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 C O C <br /> Pink - Field Copy / White & Yellow - To Laboratory with Samples / Yellow - Relum to Client with Result% <br />