Laserfiche WebLink
1 FGL ENVIRONMENTAL CHAIN-OF-CUSTODY RECORD LAB PROJcE.,�CT <br /> (-See Reverse for Instructions) NO.�v�� l J <br /> PROJECT NAME PA2d'ror. �rOL( 0"1`(,6 Jk SAMPLERS-P-,-E—��n ! <br /> SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> ) INT) DESCRIPTION CODES A. Ground Water F. oil <br /> PROJECT NUMBER_ 2-7 `� �_ A 40-ml VOA Vial��_---__-- � B Surface Water G Waste i Standard <br /> (SIGN) B Glass Liter E Brass Tube C Leachate H BlanklSpike —' <br /> RECODER Q C Plastic 500-ml F Other _ - D Rinseate I Other_. -_ 3 60 Hour <br /> (SIGN) D Plastic Liter _ -__ E Soil/Sediment 4. Other <br /> NUMBER OF ANA SIS REQUESTED LABORATORY USE ONLY <br /> i <br /> CONTAINERS <br /> aAND 4 $ d g <br /> _'m PRESERVATION $_ $g =Sq—a— <br /> u$ E E¢ =t SAMPLE <br /> ci Z J $' ¢ E` v"<� NOTES ASSIGNED CONDITION J <br /> DATE TIME SAMPLE ID - �. V WO �� BOTTLE UPON <br /> NUMBERS RECEIPT NOTES <br /> ►o S 3 11;30 a To -M W - d ✓ 1 ✓ ` 1 <br /> To -r^'n7 7 A ✓ t ✓ � 1 <br /> I <br /> NOTES/MISCELLANEOUS s 1 nquis ed by: (Signature) Received By: (Si nature) Date Time <br /> �Z VQ 14 tat, Saw.��t • f <br /> eli uis d y: (Signature) ceive By' ignature) Date Time 7 <br /> �►- �(� -0� VA �o <br /> j4inq sh d B : (Signature) Received By: (Sin Date Time <br /> Method of Shipment Description of "' Other Chains-Of-Custody Dispatched By: (Signature) Date me Recoived for lab By: (Signature) Date Time j <br /> Transport Container Transported with this <br /> Chain (by Serial No.) <br /> 10/4 k3 5 '3oPpl <br /> Send Lab Results to (Name): (Check Office Below) Verb Requested: Yes ❑ No ❑ <br /> ❑ SANTA PAULA <br /> ❑ STOCKTON ❑VISAI.IA <br /> TEL (805) 659-0910 TEL (209) 942-0181 TEL (209) 734-9473 <br /> FAX (805) 525-4172 FAk (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 /> WHITE:Field Copy YELLOW:Proicct Copy PINK:Lahoratory Qrp� <br />