Laserfiche WebLink
L <br /> O�tM 1 S 77�- <br /> Rd r. <br /> • LAB ROJECT <br /> 106 frau FGL ENVIRONMENTAL CHAIN-OF-CUSTODY RECORD <br /> 2 (See Reverse for Instructions) NO <br /> IROJECT NAMEA,+—&c--i-- !t E'' L SAMPLERS _ l SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> f� —� NT 0 mt VOA Vial CODES A GrounS"riac Water F Od <br /> IROJECT NUMBER _ __ A Glass <br /> ss VOA veal C Senate Ovate G waste t 5 Day d <br /> i G B Glass Gter E Brass Tu C Leachate H Blank/Spike 2 5 Day <br /> RECORDER C Plastic 506 ml 1` er ___ D k Other _ 760 tiou, <br /> D Plast c Liter _ _- �_ E SallS d men, — 4 Omer <br /> (SIGN) <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS U <br /> AND <br /> n - <br /> ±� n PRESERVAIiDN a k �- <br /> SAMPLE <br /> o 4u ¢ NOTES ASSIGNED CONDITION <br /> BOTTLE UPON <br /> UPpEl TIME.,1lME.,j SAMPLE ID H h N Z NUMBERS RECEIPT NATES <br /> •y �fa/ arws J 3� <br /> �1 w3 <br /> r <br /> r <br /> ;1 ll <br /> i <br /> �� J � ehn Is d St nature) Rec (Signature) Date Time <br /> j0j�ES!MISCELLANEOUS / d, � { 9 9 I _ <br /> c ]ata TlmeFellnqulshed By (Signature) i <br /> kl4*—. Relinquished By (Signature) Received By (Signature) Date Time <br /> ,pox �--/�J 5•�� �- <br /> Method of Shipment Description of Other Chains Of Custody Ispatched By (Signature) Date Time Received for lab By (Signature) Date Time <br /> Transport Container Transported with this <br /> ee c-4 <br /> /G T Chain (by Serial No) <br /> Send Lab Results to (Name) (Check Office Below) Verbals Requested Yes ❑ No ❑ <br /> ❑ SANTA PAULA Q—fr CKTON ❑VISALIA <br /> TEL (805) 659-0910 TEL (209) 942-0181 TEL (209) 734-9473 <br /> FAX (805) 525-4172 FAX (209) 942-0423 FAX (209) 738-6273 <br /> Hol. ENVIRONMENTAL LABORATORY • 2500 STAGECOACH ROAD • SIOCKYON, CA 45215 a TEL (209) 942-0181 • FAX (209) 9424423 <br /> K 111 tt 1 IJd C„p? 5I I 1 OW Pr Niru L y,t PINK L,N—tuq Gyne <br />