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1 i i <br /> �1 FGI. ENVIRONMENTAL CHAIN-OF-CUSTODY1' <br /> RECORD LAB PHo.11`c�' <br /> (See Reverse for Instructions) <br /> f 4iOJEC'C NAME �,C.fl.�7er�� � P��Py1�S _ SAMPLERS /�-. <br /> Sf <br /> SAMPLE CONTAINER SAMPLE DESCRIPTION CODES JAI CODES —7 <br /> } 'n DESCRIPTION CODES A Ground w,knn I <br /> A aPRsJ tECT NUMBER L�tL o-:nural l CR <br /> B Surface water <br /> RECORDER V �/�, B Glass Unef E Brass Tube C Leachate if k31ank1SNr.e 2 <br /> ', s� _ _.__—_— G. Plastic 500-m1 F Omer - f3 Hrnsea3e I Dlhc� ep H—,24 351GNI G PELSL[Leer _ E. SodlSeounenl <br /> a Gmer <br /> 1 NUMBER OF ANALYSIS REQUESTED 4 <br /> CONTAINERS LABORATORY USE ONLY <br /> ANO <br /> PRESERVAI ION <br /> c ° <br /> SAMPLE <br /> LI _ awl NOTES ASSIGNED i CONDITION I j <br /> DATE I TIME SAMPLE ID Is. lig r BOTTLE II UPON <br /> NUMBERS f RECEIPT NOTES <br /> ry z <br /> IA If/- <br /> 1 �r i - - - —_ - - - - - - - <br /> tl�1�Y! <br /> Ir —Cnz�zs-o <br /> Wal <br /> NOTES!M15CEL-LA NEOUS - <br /> Relinquished b", (Signature) i (Sign i e Date --f,rne <br /> �C-E eNES T FiPa.�t ��,L R )r quish ignature) Aece d 5icture <br /> y a y� b:3 o,4�t - � ( J <br /> } Dale Time <br /> a in ished- : (Signature) R eived By: (S"gn ure - at, Time <br /> Method of Shipment Description of Other Chains--- <br /> 01-Custody Dispatched By: (Signature) Date Time - 797 <br /> Transport Container Transported with this r 19 azure) ate -Tuna <br /> Chain (by Serial No.) <br /> Send Lab Results to (Name)-.0) e)-- ,Z7Gr(Mfof� 2� +unr, 9 s- — -- ---- --__ _-- -.. <br /> _ - (Check Office Below) Verbals Requested: Yes No <br /> U SANTA PAULA ❑ S7'UCti1'UN 141 74-7YA/ �C <br /> TEL (805) 65L)-0910 V1SALAA <br /> TEL (209) 942-0181 <br /> FAX (905) 52�-4172 FAX (209) 942-0423 1'LL {2U(I) 734-9473 <br /> FAX (209) 738-0273 <br /> 1''(;,1. ENVIRONINIENA'A1, I.ARORA"PORI' • 2-5oo S'FAGECOACII ROAD • S'1'OCK'I'ON, CA 9521- • 'I�F[,.(20) 942-0181 FAX (2119) 942-0423 <br /> u'lll'I'F. Fn"kl C'up1'P.I i( I Cn I'Qhlt L.,Lualrn ('n3. <br /> J, P <br /> � y <br />