Laserfiche WebLink
• <br /> FGL ENVIRONMENTAL CHAIN-OF-CUSTODY RECORD LAB PROJECT <br /> V,4LI„� (See Reverse for Instructions) NO <br /> PROJECT NAME ('', SAMPLERS° %` —1.1 5 r FPiaslicUier <br /> CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> PROJECT NUMBER r f r - / (PRINT,} PTION CODES A Ground Water F Oil _ _ <br /> -� 1/ i'� .i ! C.L� t V,ai B Surface Wafer G Wasse Stand rd,� <br /> (SIGN) i"E Brass Tube C <br /> r i, �. Leachate H Blank/Spike 2 'S Day <br /> RECORDER f'r�t L - ml D Rinseaie I Other 3 6o Hour <br /> (SIGN) E- So,USed,me-t 4 Ofher <br /> NUMBER OF ANALYSIS REQUESTED <br /> CONTAINERS LABORATORY USE ONLY <br /> c AND <br /> � a u <br /> PRESERVATION $ ( �, �8 s vi nY <br /> g m v <br /> 3� <br /> C. _.. a m� SAMPLE <br /> _ m o s" '$ m NOTES ASSIGNED CONDITION <br /> ES 3m n Z_ m" M b V<U <br /> DATE TIME SAMPLE ID N LL �� ov BOTTLE UPON <br /> r <br /> z NUMBERS RECEIPT NOTES <br /> cz A <br /> +t <br /> t <br /> e--7 , I <br /> NOTES!MISCELLANEOUS R in wished b <br /> /t �f ,/ / q y_( nature) Rece vydyv{5lgnature) Date Time <br /> r' 7�'i !!��/t-!/�� / r i t ,,tt <br /> r�?� r l <br /> r <br /> 74.13 Relinquished By (Sig lure) Received By (Signature) 1 Date Time <br /> Relinquished By (Signature) Received By (Signature) Date Time <br /> Method of Shipment Description of Other Chains-Of Custody Dispatched By (Signature) Date TIm� Received for lab B (Signature) <br /> Transport Container Transported with this Y Date Time <br /> H. Cxft+ Chain (by Serial No) <br /> Send Lab Results to (Name) r�pc, (Check Office Below) Verbals Requested Yes ❑ No ❑ <br /> ❑ SANTA PAULA Z�?.cJ �_ I f5 ❑ STOCKTON <br /> TEL (805) 659-0910 `'r f ❑VISALIA <br /> FAX (805) 525-4172 Jam` 1 r)' TEL {209) 942-0181 TEL (209) 734-9473 <br /> FAX (209) 942-0423 FAX (209) 738-6273 <br /> FGL ENVIRONMENTAL LABORATORY • 2500 STAGECOACH ROAD • STOCKTON, CA 95215 • TEL (209) 942-0181 • FAX (209) 942-0423 <br /> 'AHITE F„Id C,p, }FLLOW Pngcu Cap, PINK Lnt.,ratnry Cip� <br /> k ( s <br />