Laserfiche WebLink
WAN <br /> FGL ENVIRONMENTAL &AIN-OF-CUSTODY REc®�� - <br /> q5 1W <br /> X13 PROJECT 1� <br /> Pno ECr NAM �'�vt�t: /,` tie Reverse for IRstructintuj NO. <br /> _ ! Y�.fO SAMPLERS—D., �/ rr � 1 <br /> -�. f �j. f '. SAMPLE CONTAINER SAMPLE DESCRIPTION CODES <br /> PROJECT NUMBE R�� _�/Gt �Q/ /t bl jTe LI/i L�^ DESCRIPTION CODES A Ground water F. 0.1 TAT CODES <br /> J-.�-J_. CF, l(T I A.<0-m!VOA Vial e.Sureace Wafer G <br /> s rr-Glass luer 8,$rnss iube C Waste 1.Slanoara <br /> RECORDER / Leachate H elanelSylAe 2 5 par <br /> .. s. ''*J{N1 C.Plas&c 500-mi F Olner-__,-_ D.Rtn,eare <br /> (SIGN) WI f� D.Plashc U., 1.Other 3 60 Hour <br /> - —TE.SaiBSetl,ment . <br /> -_ ..._-.,-- -. 4 Othw <br /> NUMBER OP ANALYSIS REQUESTED <br /> CONTAINERS LABORATORY USE ONLY - y <br /> • n AND R u <br /> `- - PRESERVATION $ <br /> SAMPLE <br /> DAT TIME SAMPLE Ip a 3E au V '<� Eo NOTES ASSIGNED CONDITION <br /> y s ✓ BOTTLE UPON <br /> NUMBERS RECEIPT NOTES <br /> Y <br /> I— <br /> I - <br /> i <br /> i <br /> 3 <br /> NOTESfMISCELLANEOUS <br /> f4r��a fjelinquiShed by:(Signature) R eived By:(Signature) Date Time <br /> g.GK aDca,y<</ <br /> �/+ 5WI� elinquished By:(Signature) - eCeived BY:(Signature) <br /> dtfi',17e1 v ( 9 1 Dato Time <br /> a <br /> s}7a f <br /> -('0 e�'r9 C t'-`'s� Relinquished By:(Signature) Received By:{Signature) Date lime a <br /> c jgft+FLaTG+ G1� yj�e� <br /> �t {Shipment Dascdplion ct OlYter Chalns-Ot-Custody Dispatched By:(Signature) Dase <br /> Transport Container Transported with this Time Received for lab By:(Signature) Date Time <br /> L�QIE-+l (�& <br /> Chain(by Sarlal No.) <br /> Send Lab Results'to (Name): <br /> ❑ SANTA PAULA; <br /> (Check Office Below) Verbals Requested: Yes ❑ No ❑ <br /> TEL(805)65910914 STOCKTON ❑VE5ALIA <br /> FAX 0805)525-4172 <br /> TEL (209)942-0181 <br /> FAX (209)942-0423 TEL (209) 734-9473 <br /> FULIENVIRONMENTAL LABORATORY a 2560 S 1'AGECOACH ROAD•STOC1fTON,CA 95215•TEL.209 FAX (204) 738-6273 <br /> htcW C.,p) YI:1-111w.Pr.9e.t C.;ry PINK: TEL.(209) FAX (209)Stix-0423 ,~ <br /> i <br /> c• p <br /> I <br /> I <br /> I. <br /> i <br /> �i <br /> -;1 <br />