Laserfiche WebLink
FGL ENVIRONMENTAL Ct�1IN-OF-CUSTODY RECORD ,B PROJECT <br /> e';) (See Reverse for Instructions) NO. <br /> PROJECT NAME kb L`_ll0L...TY•G4`ri v, _ SAMPLERS F►'I _rI T e,{� SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> _ INT) DESCRIPTION CODES A Ground Water F. Oil <br /> PROJECT NUMBER 21.50_ A. 40-mi VOA Viat B Surface water G. waste t Standard <br /> (SlGivl 8. Glass Liter E. Brass Tube C- Leachate H, Blank/Spike 2. 5 Day <br /> RECORDER la <br /> I, atic 500-m1 F.Other O. Rinseate I. Other 1. so Hour <br /> (SIGN) D. PlastiCLiter —,_______ E- SoilJSediment �_ a, Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> AND ° n <br /> – a PRESERVAT{ON <br /> ; $ Q E. I: SAMPLE <br /> nd o �� 9? a c R 8 ""a� NOTES ASSIGNED CONDITION <br /> H Ev T z Q 4" EY o BOTTLE UPON <br /> DATE TIME SAMPLE ID z = NUMBERS RECEIPT NOTES <br /> NOTES 1 MISCELLANEOUS TirLIC kms!H� �"(x, oefi hed na re) Rived By: (Signature) Date Time <br /> r-rrinwished Bc>v�f j�. 5 fCYCf'� �/� �S �5 "�Tr'�°�SL�y��� nature Received B Si a Date Time <br /> Y: ( 9 ) Y (Sig <br /> linquished By: (Signature) Received By: (Signature) 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 /> Chain (by Serial No.) <br /> C� ry a3�ti L 1�y o <br /> Send Lab Results to (Name): M. Lry' tr t•1 ct%. z120yr+ (Jis-f Pr -Sade 1 902gCheck Office Below) Verbals Wequested. Yes ❑ No ❑ <br /> ❑ SANTA PAULA ❑ STOCKTON \G)li,'> Ct � r��� ❑VISALIA <br /> TEL (805) 659-0910 TEL (209) 942-0181.(A(_> ��� _���3 Fc�y TEL (209) 734-9473 <br /> FAX (805) 525-4172 FAX (209) 942-0423 FAX (209) 738-6273 <br /> F(A. FNVIRONNIENTAL LABORATORY • 2500 STAGECOACH ROAD • STOCKTON, CA 95215 • TEL.(209) 942-0181 * FAX (209) 942-4423 <br /> WHITE: Field 0,py YELLOW Pmjrct C,+py PINK: Lahnramry C,�py <br />