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FG1. ENVIRONMENTAL CHAIN-OF-CUSTODY (6�30 Ll <br /> 2500 STAGECOACH ROAD e S'IDCKTON, CA 95215 • (209) 942-0181 • FAX (209) 942-0423 Lab Number <br /> ' SAMPLE MATRIX CODES PRESERVATIVES <br /> Client: C 2'�� �( , V _ PrOJ@Ct Name: _���_ •,wt' —.—_--_ CONTAINER CODES B = Blank SL = Sludge A HCI <br /> B = Ba DW - Drinking Water SP = Spike B HNO3 <br /> Address: -� 7 7� /'\ IL <br /> C ` S' ,`G r-Ct— Project Number: _— BT = Brass Tube GW = Ground Water SW=Surface Water C NaOH <br /> G = Glass L - Leachate W = Waste D H2SO4 <br /> City: 1-� _State: � Zip-`LT.Sy�7.7� /ti Contact Person: 1`�'��y �,�- �( P = Plastic MW = Monitoring Well WI = Wipe E Zn Acetate <br /> t V = VOA Vial O = Oil WW - Waste Water F Na2SA3 <br /> Phon :)�_�2"•3�_1[5_ _ Fax: _ _— Sampler: (print) r � f �•-� o = other - _-__ s = Son x = Other G Other <br /> JL <br /> ANALYSIS REQUESTED W <br /> CONDITION OF INITIALS <br /> SAMPLE NUMBER/LD. LOCATION/DFSCL�IPTIOLJ DATE TIME a w ' <br /> SAMPLED SAMPLED o< a a ¢ `� o� LL" b SAMPLES UPON <br /> z10 w RECEIPT <br /> v n OU w U <br /> IJ <br /> l <br /> 1 •lit 7 ',4i•nul:st;•,-�flL <br /> Sk; - — <br /> ( / <br /> li a <br /> RELIN�UISHED BY SAMPLER: DATE/TIME RECEIVED BY: DATE/TIME <br /> COMMENTS: lL, L ns. !r <br /> RELI QUI EO BY: DATE/TIM RECEIVE DATE/TI E <br /> P.O. RELINO ATE/TIME / RECEIVED BY: E/TI E <br /> QA/QC Required? Y_N_ State Forms Required? Y_ N_ ' <br /> RELINQUISHED BY: DATE/TIME RECEI BY LAB. DATE/ ME <br /> Turn-around Time Normal —_ Rush <br /> (Subject to Surcharge) <br /> Y' <br /> CORPORATE OFFICE & LABORATORY FIELD OFFICE <br /> PO. BOX 272, 853 Corporation Street Visalia, California <br /> Santa Paula, CA 93060 Telephone: (209) 734-9473 <br /> Telephone: (805) 659-0910 Mobile: (209) 738-6273 <br /> ,­, ten. n171) WIAITF 1 ahnratnry r.nnv YFt LOW Customer CooV PINK: Field Copy Fax: (209) 734-8435 <br />