Laserfiche WebLink
r FGL t NVIRONMLNTAL CHAIN-OF-CUSTODY RE CORD LAB PROJECT <br /> (See Reverse for.Instructions) NO. <br /> •,PROJECT NAME J `. -) t_ j}r-�ILv f�t� \\lf `` 4 <br /> SAMPLERS" �J ?- {1 N`���+� SAMPLE CONTAINER SAMPLE DESCRIPTION CODES .TAT CODES <br /> PROJECT NUMBER ),FJG�'j�j;,- IPnIN���/ ,l�7 DESCRIPTION CODES A Gro.nd WAler F. Oil <br /> yy (AD ml VOA Vial' B. Surface Water G. Waste <br /> (SIGN) B. Glass Liter F. erase Tube C. Leachate ( Standard <br /> RECORDER kf�Blanwspike 2. s Day <br /> C. Plastic 500-ml F.Olhar D. Rinseale I. Other 3. 5 Bout <br /> (SIGN) D. Plastic Liter E. SnillSedimenl <br /> 4. Other <br /> Numarn OF ANALYSIS REQUESTED - <br /> CONTAINERBO RATORY USE ONLY <br /> i - <br /> AND <br /> LA <br /> u ; <br /> PRESERVATION 1 11) <br /> cS g •� <br /> o �u 2§ € �_ SAMPLE <br /> = 4` a 1 �€ �' - NOTES ASSIGNED CONDITION <br /> E TIME <br /> SAMPLEIDL BOTTLE UPON <br /> �_rrs � + <br /> '9I E-50E-50Cap L — NUMBERS RECEIPT 'NOTES <br /> Gp l l[x000 � A A 1 - <br /> p IIU -U -� l - <br /> ->« ... _ � <br /> -� - - - <br /> 1711 <br /> 33 SD m — <br /> M � --.. ... .. .. . . .... ... <br /> �I p <br /> �7 O <br /> dro g-40 <br /> rn_ <br /> -- — — <br /> m <br /> Ro i Tquis I led �(Sture) Ae eivad By: (Signature) Dale Time <br /> Relinqu s ed By: ( ignature) — eceived By; (Signature) Date 71rr <br /> Relinquished By: (Signature) ReCelved By:(Signature) Date Time <br /> Method of Shipment Description of Other Chains-Ol-Custod ibis alched 8 : Si nature <br /> idl � ,♦� Transport Container Transported with Ihis <br /> y p Y ( 9 ) Dale Time Received for lab By:(Signature) Date Time <br /> -.1 } Chain (by Serial No.) K <br /> Send Lab Results to (Name): <br /> SANTA PAULA ❑ S'1'UCI{'i'VN (Check Office Below) Verbals Requested: Yes ❑ No ❑ <br /> ❑ <br /> TEL (905) 659-0910 TEL (209) 942-0181 ❑VISALIA <br /> FAX (805) 523-4172 FAX (209) 942-0423. T[:L (209) 734-9473 <br /> FAX (209) 738-6273 <br /> ta. 1'(.l, i;NVIRONNIENTAL LABORATORY • 2500 STAGUCOACII ROAD • STOCKTON, CA 95215 • TEL.(209) 942-0181 • FAX (209) 942-0423 <br /> i4 i <br /> WIIITr:H(ld Cnpy VELLOW;Pmjm Cupy PINK:Laharamry Cnpy 1 <br /> ti <br />