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FGL ENVIRONMENTAL CHA OF-CUSTODY <br /> 2500 STAGECOACH ROAD • STOCKTON, CA 915215 • '(20 ) 942-0181 • FAX (209) 942-0423 Lab Number <br /> Client: �' ' ts�u tCs�..�.�ACyI Z�_r � ' ~f 1a Pro ect Name:� _�� �=�� l21 5 SAMPLE MATRIX CODES PRESERVATIVES <br /> I t� CONTAINER CODES B = Blank SL = Sludge ^A HCI <br /> B Bag DW = Drinking Water SP = Spike B HNO3 <br /> Address: `��• �.��� �Y`•� Project Number: ��i::. i>> `� <br /> J u BT r= Brass Tube GW = Ground Water SW=Surface Water C NaOH <br /> Lilt �• ��� iE; State: +�' .l����,w," ;" it G = Glass L = Leachate W = Waste D HZSOi <br /> City: - • Zip: - Contact Person: .�1� V, P = Plastic W�= Monitoring Well WI =Wipe E Zn Acetate <br /> 0 VOA Vial = Oil WW = Waste Water F Na2%% <br /> i ` ; 'ISampler: (p ) t�7 -Qla� � �a O = Other S = Soil X = Other G Other <br /> Phone: -.= i Fax: tint 1' � .y-L� �, `�—, <br /> w ° ANALYSIS REQUESTED ` CONDITION OF INITIALS <br /> SAMPLE NUMBER/I.D. LOCATION/DESCRIPTION DATE TIME ¢ ' W— ?w �- <br /> SAMPLED SAMPLED LL z a ` >? SAMPLES UPON <br /> °Z o f W " o Y r; �: v RECEIPT <br /> U ¢ O <br /> rw <br /> Al <br /> i3 J9� ..t L;�ln-�'• .��� L. tJ �'` l/ r`a'J bJ f^ <br /> COMMENTS:' '`�'.t RELINQUISHED BY SAMPLER: DATE/TIME RECEIVED BY: DATE/TIME <br /> µ~ - <br /> C", RELINQUISHED BY: DATE/TIME RECEIVED BY: DATE/TIME <br /> P.O. # e. ,., ,.j; s /)' RELINQUISHED BY: DATE/TIME RECEIVED BY: DATE/TIME <br /> QA/QC Required?Y/N_ State Forms Required? Y_N_ <br /> RELINQUISHED BY: DATEITIME RECEIVED BY LAB: DATE/TIME <br /> Turn-around Time Normal Rush <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 />