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' FGA, ENVIRONMENTAL C�,�T=Off'-CUSTODY RECORD <br /> *041113 PROJECT <br /> ' (See Reverse for Im--tructions) NO. IT <br /> 'i'RGk1E&F NAME.-.- T _ 4UJL1 SAMPLERS # [6 VARA SAMPLE CONTJUNER SAMPLE DESCRIPTION CODES TAT CODES <br /> IPHINT) DESCPI PTiON 000ES A. Gwwnd waiter F Oa <br /> A. a4rn VOA Vi71 0. Sudace Water ii. Waste 7. Srandard <br /> PA0.1 T NUMBER a, Guavas E. Hrs tine C. Eeatnare H. B�anhU$pike 2. 5 ua, w <br /> (SIGN) <br /> C mutic"�I F.Ulher 0. Renware L CXtm�_ � d- 6o Hour 40 <br /> RECC7fl0ER , <br /> Q Pra96c tI[er .� E. So�YBe�nern i. <br /> NumutFR of ANALYSIS REQUESTED LASORATO#IY USE ONLY � <br /> CWTAINEAs <br /> ACID 3 u _ -1 <br /> SAMPLE 71 <br /> NOTES ASSIGNED CONDITION 70 <br /> E BOTTLE UPON Y <br /> DATE TIME SAMPLE 40 NUMBERS RECEIPT NOTES <br /> I :2 -%Vht! C It _ 4}LD <br /> tt 23 1 _ VRML- ! _ - -- — <br /> li <br /> 1123 :OS Wall 13- rri <br /> i <br /> u 2:15 <br /> 0 <br /> NOTES J MISCELLANEOUS Relinquisned by. (Signalum) Received By:{Signature) Date Time <br /> Relinquished By: (Sig lure) Reeaiue¢ By: (Signa Date � Time <br /> Ae?inquish y: (Signature) Received By:(Signature) Date Time <br /> Maltmd o1 Shipment Descnplion of 1 0ther Chains-01-Cus#adX pispatihe+i By: (Signator Data Time Aero"sved for lab By: (Sigaiure) Dale Time <br /> Transport Conta iv Transported with Itis <br /> Chaim(by Serial Ilio.) <br /> rl A <br /> Send Lab Results to (Name): (Cheek Office Below) Verbaf UeSted: Yes ❑ No Q ro <br /> m <br /> ❑ SA:YTA PAULA ❑ SMCKTON ❑VISALIA � <br /> TEL f805)659-4910 TEL (249) 942-0181 TEL (209) 734-9473 CD <br /> FAX (845) 5254172 FAX (249) 942-0423 FAX (209) 738-6273 ' <br /> FGI. ENY1RUNNIENTAL LABORATORY a 25M STAGECOACH ROAD A STOCKTON, CA 95215 o TEL.(209) 942-0181 FAX (209) 942-0423 <br /> na <br /> WJ41rE:1=kN Cipy YELLOW:Pn.Veci Ciao PINK:L4wramyC.-5 <br />