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11,110, <br /> . i movllrrlw <br /> F GL ENVIRONMENTAL CHAIN-OF-CUSTODY RECORD LAB PnOJECI <br /> L `, (See Reverse for Ins(!uc(ions) NO <br /> PROJECT NAME S J-pc* �)1'1 7_11 SAMPLERS MV-e�z- <br /> PSAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> DESCRIPTION CODES A Ground water F O'l <br /> PROJECT NUMBER r/v �W(�cC DA 40 ink VOA Vnl a sur+ace waren G waIp I Srandard <br /> (SIGN] a Glass Luer E Mass Tube C Leachate If Blankrsp." 2 5 Day <br /> RECOPiDER C Plastic 500 ml F Olher p Rinseale I 011ie._— _— 3 eo Hour <br /> (SIGN] b Phsl.c Lder _ _ _ E So.USed.meni _ _ 4 Other <br /> NUMeEn Or ANALis nEQUESTED LABORATORY USE ONLY <br /> COMAINERs <br /> 4 u <br /> u AND <br /> o- v 4_ y- <br /> c� PRESERVATION P „a A <br /> ; 9- <br /> §� r: <br /> ( SAMPLE <br /> Eat NOTES ASSIGNED CONDITION <br /> e BOTTLE UPON TIME SAMrEID EIPT <br /> NOTES z NUMBERS REC <br /> T po — }bV- 113 <br /> — — x— <br /> NOTES!MISCELLANEOUS1 _ h qui t d {Sl r Reserved Bhy [Sign lure} Da _ 11me <br /> LA <br /> Kell,qulshe B ( i nature ece ed I nal e <br /> Y 9 ) Y ate Tine <br /> _ - k– — relrnq—UMI Signature) Recd By (Signature) Dale Time <br /> Method of ShipmenE Description of 01her Chains Of Custody Dispatched By (Signature) Date Time Received for lab By (Signature) DateTime <br /> Transport Container Transported with this <br /> Chain (by Serial No} <br /> Send Lab Results to (Name) (Check Office Below) Verbals Requested Yes ❑ No O <br /> ❑ SAN CA PAULA ❑ S 10CK 1 ON ❑VISA HA <br /> I FL (805) 659 (19 10 TCL (209) 942-0181 TLL (209) 734-9473 <br /> 1 AX (805) 525 4172 f AX (209) 942-0423 YAX (209) 738 6271 <br /> 1 GI I NVIRONMI N I Al, LA110IIA 1011Y • 25(}0 51 AGECOACH ROAD • S-10CM-ON, CA 95215 + 41-L (209) 942-0181 • FAX (209) 942-0423 <br /> aNlll 1..IJ[.p. lilrrlN lulrarr.p, LINK I,N.,.....r p. <br />