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F <br /> GL ENVIRONMENTAL COor <br /> -OF-CUSTODY RECORD 013 PROJECT <br /> r - (See Reversnstructions) ,NO. <br /> PROJECT NAME !ZLUM P __ SAMPLERS ly��i� SAMPLE CONTAINER SAMPLE DESCRIPTION CODES_ TAT CODES <br />* �r)( RI DESCRIPTION CODES A Ground Water F Oil r - <br /> s W A 40-ml VOA VW B Surface Water - O Waste ' s andard <br /> PROJECT NUMBER —:7ISIGN) 8 Glass Liter E Brass Tube C Leachate H Blank/Spike " - 2 5 Day V N Y <br /> C Plastic 500-m1 F Other D R nseate 1 Other ` 3 60 Hour <br /> RECORDER D Plastic Liter E Sod/Sedlment 4 Other <br />� �� _ _ tsle - _ --' <br /> f - £ - ro NUMBER OF ANALYSIS REQUESTED n= LABORATORY USE ONLY <br /> CONTAINERS <br /> `o AND ° 'r <br /> i t / Dir u+►s^� We# � `8 PRESERVATION $y �1 y g =Y r v <br /> y� € SAMPLE <br /> e t " NOTES ASSIGNED CONDITION <br /> E`€e 14 p �` s E BOTTLE -' UPON _ " <br /> m z NUMBERS '; RECEIPT NOTES r I <br /> DATE TIME ; ; SAMPLE ID _ <br /> fir - <br /> *VW- [ <br /> € _ G, Wo {r <br /> MFS �� f a F } �'p• T"'' *`rte' , T� • ';fid <br /> F V T � - • � v <br /> /210 <br /> 12f'5_ 1 A4W* <br /> - 222 <br /> 2 +)e V <br /> 12 - MW-7— 35 '(a' u <br /> linq i hed by I nature) Received By Signature) Date Time <br /> NOTES/MISCELLANEOUS /0 ,��f(�p'y'� LUPIdHP ` , 1 f J + tot-', 1! jr) 1(- 4r <br /> F <br /> 1211 Sa. Turav,1CG g'SZoG u,shed By (Signature) R eived By (Signature) Date Time <br /> t/,s A Dr r rn SFClvf{'S 6 Z S' <br /> r r <br /> r <br /> l �( 'Relinquished By (Signature) Received By (Signature) Date Time <br /> F I _- <br /> Method of Shipment Description of Other Chains-Of Custody Dispatched By (Signature) Date Time Received for lab By (Signature) Date Time <br /> Transport Container Transported with this <br /> elf l2 lc:GCAP5 r- Chain(by Serial No) <br /> I <br /> lsic� / rdx) Check Office Below Verbals'Requested Yes 13 No ❑ ' <br /> Send Lab Results to (Name) l�/m '�f��' y1Z- 63 __ ( ) <br /> ❑ SANTA PAULA ❑ STOCKTON ❑VISALIA <br /> TEL (805) 659-0910 TEL (209) 942-0181 _ TEL (209) 734-9473 <br /> FAX (805) 525-4172 - - FAX (209) 942-0423 FAX (209) 73&6273 <br /> FGA.ENVJRO�rENTAL LABORATORY • 2500 STAGECOACH ROAD • STOCKTON, CA 95215 • TEL(209) 942-0181 FAX (209) 941-0423 r' <br /> _ , WHITE Field Copy YELLOW Pmjea Cup% PINK Labnratory Copy <br />