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u <br /> FGL ENVIRONMENTAL CHAIN-OF-CUSTODY �� <br /> 2500 STAGECOACH ROAD • STOCKTON, CA 95215 • (209) 942-0181 • FAX (209) 942-0423 Lab Number <br /> Client: -� ,Y1U t 1MGn� Project Name:Cj(EU �6l/Y1CJ, lZi S SAMPLE MATRIX CODES PRESERVATIVES <br /> �rpA 17-1 S. <br /> CONTAINER CODES B = Blank SL = Sludge A HCI <br /> Address: Pte• Zr?jQ v1 :G - <br /> Bag DW = Drinking Water SP = Spike B HNO3 <br /> �Lr Project Number: 01M� M a� = Brass Tube GW = Ground Water SW=Surface Water C NaOH <br /> City: ii :/?�ZD 1 Glass L = Leachate W = Waste D H,SO, <br /> Y T v\ State: Gfk- Zip IRS Contact Person: ff\ L �6,'r Z �V Plastic = Monitoring Well WI =Wipe E Zn Acetate <br /> Phone: 6R" 3 $ f, VOA Vial :P= <br /> Oil WW = Waste Water F Na2S203 <br /> Fax: Sampler: (print) Mz( ��, (bCJA 0 = Other S = Soil x = other G Other <br /> ° ANALYSIS REQUESTED <br /> SAMPLE NUMBER/1.D. LOCATION/DESCRIPTION DATE TIME W W w x < ¢Z Z CONDITION OF INITIALS <br /> SAMPLED SAMPLED ` SAMPLES UPON <br /> O a u Q 00 <br /> LL � 1 0— <br /> o Q o o 5 :r RECEIPT <br /> a U w 4 v <br /> V mW 4,L GPJ res <br /> 6 Y11 tnI ' •30•Ci : )l A U <br /> i V MW v.- 13Liz,s <br /> +'N tti - o- 2:2 Z mw .� G <br /> $•30 9y 15 Z J raw ou. rN jv rA „� 5J <br /> 3.6 M W— g 3a-�U 'S �+� G v S <br /> COMMENTS:W O•-TD -D1 5 T j��� NQ I HED B MPLE DATE/TIME RECEIVED BY: DATE/TIME <br /> (� P`/ RELINQUISHED BY: DATE/TIME RECEIVED BY: DATE/TIME <br /> P.O. # 771V'AC' 7 <br /> / RELINQUISHED BY: DATE/TIME RECEIVE DATE/TIME <br /> QA/QC Required?Yom/ N_ State Forms Required? Y5_,nvN-v—[// <br /> RELINQUISH DATE/TIME RECEIV Y LAB: �O DAT <br /> E/TIME <br /> Turn-around Time Normal Rush K, O�0 G�( (D rZ <br /> (Subject to Surcharge) <br /> CORPORATE OFFICE & LABORATORY FIELD OFFICE <br /> P.O. 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 /> Fax: (805)525-4172 WHITE: Laboratory Copy YELLOW: Customer Copy PINK: Field Copy Fax: (209) 734-8435 <br />