Laserfiche WebLink
M M Mir M Y _ M M ism _ h <br /> FGL ENVIRONMENTAL CHAIN-OF-CUSTODY RECORD LAB PROJECT <br /> (See Reverse for Instructions) NO <br /> r <br /> PROJECT NAME /0 ��an4-A Z SAMPLERS Wj 11WIt SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> Rl DESCRIPTION CODES A Groundwater F oal <br /> PROJECT NUMBER WALE5 �Fr r��� (�{ L( A 40-ml VOA vial B Surface Water a waste 1 Standard <br /> B Glass Luer E Brass Tube C Leachate H BlanWSpike 2 5 Day <br /> 1/ <br /> RECORDER �-L�-C r'C, 1 ' c Plastrc 500-mi F Other D Rtnseate I Other 3 60 Hour <br /> a <br /> (SIGN) tW D Plastic Liter E SoiliSediment 4 Other <br /> t NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> € ANDg <br /> o gm PRESERVATION $ $m g m <br /> � 3 <br /> LL ff'gE¢ N._ SAMPLE <br /> 9 3NOTES ASSIGNED CONDITION <br /> DATE TIME SAMPLE ID <br /> ym LLBOTTLE UPON <br /> z NUMBERS RECEIPT NOTES <br /> 1(e 4-5- Al ' '' I G <br /> 4440- 5 10"41' it i <br /> 7/7 pL <br /> wL O - <br /> 2� //3o w- 16 x u , sd <br /> NOTES 1 MISCELLANEOUS I ui =ure) , Receive¢ By (Slghature) ate Time <br /> 13IL[�A.j6 T4 /�AA.VUrc S/�2ryr Z <br /> /G 33 �v. rvAc,c,4 r sr s ,xrrn� C t <br /> T r shed By ( Ignature� Receive -By (Signature) Date Time <br /> Ilnquished By (Signature) Received By (Signature) Date Time <br /> Method of Shipment Description of Other Chains-Of-Custody Dispatched By (Signature) Date Time Received for lab By (Signature) Date Time <br /> Transport Container Transported with this <br /> K/s <br /> 4*/1,,7T Chain(by Serial No) ' <br /> Send Lab Results to (Name) Z L1,5k r (Check Office Below) Verbals Requested Yes ❑ No ❑ - <br /> El SANTA PAULA A 9161%JZ-1693 ❑ STOCKTON 1;�4c `iS bz r ❑VISALIA <br /> TEL (805) 659-0910 TEL (209) 942-0181 TEL (209) 734-9473 <br /> FAX (805) 5254172 FAX (209) 942-0423 FAX (209) 738-6273 <br /> r_ FGL ENVIRONMENTAL LABORATORY Y 2500 STAGECOACH ROAD o STOCKTON, CA 95215 • TEL.(209) 942-0181 • FAX (209) 942-0423 <br /> • _ WHITE Fuld Copy YELLOW Pmject Cop+ PINK Latmratnry Cnpy <br />