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FGL ENVIRONMENTAL CHA-OF-CUSTODY RECORD IOROJECT <br /> !� p 75 (See Reverse for Instruction) NO. <br /> PROJECT NAME 'J(°091IA Ufu/ SAMPLERS • t' SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> G DESCRIPTION CODES A Ground water F C41PROJECT NUMBER 1 L L 4M��r trr/ I/' A aa.ml VOA VW a Surface water G waste t standard <br /> "(s i N) B Glass Liter E Brass Tube C Leachate H Blank,Splke 2 Day <br /> R+r+ <br /> + / C Plasuc 500-ml F Other D seate I Other 60 Haar <br /> RECORDER D Plastic Liter E SoiUSediment 4 other <br /> (SIGN) L <br /> t <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> + CONTAINERS v <br /> A AND <br /> ag` Y8 PRESERVAT <br /> cc �Y u ION SAMPLE <br /> o <br /> 3� NOTES ASSIGNED CONDITION <br /> E� F� a x LL' i E >— BOTTLE UPON <br /> DATE TIME SAMPLE 1D +� _ A = NUMBERS RECEIPT NOTES <br /> I'Ano <br /> i r r y <br /> 2sc> _ <br /> ! ! <br /> 31SO V t 1 <br /> Itly <br /> 19)0 <br /> ov - ` <br /> 3 3 S � <br /> 7 75,40 > > > `[ L( <br /> - <br /> ! <br /> NOTES l MISCELLANEOUS 1 ell (shed try n tore) Received By (Signature) Date Tlme <br /> Of <br /> 70,-7sbnquished By (Signature) Received By (Signa Date Time <br /> i, <br /> Relinquished By (Signature) Received-By (Signature) Date Time <br /> Method of Shipment Description of Other Chatns-Of-Custody Dispatched By (Signature)' Date Time Received for lab By (Signature) Date Time <br /> Transport Container Transported with this <br /> Chain (by Serial No) f� j i t y /+yf1 L ,,'PjV" <br /> Send Lab Results to (Name) l ' ! rr r r 'Z" ^o'n�� I�,c), 9r �G-r �s Check Office Below) Verbals ReJuested Yes ❑ No ❑ <br /> ❑ SANTA PAULA FAI (7�&) 771 �,f� '� ❑ STOCKTON ❑VISALIA <br /> TEL (805) 659-0910 TEL (209) 942-0181' TEL (209) 734-9473 <br /> FAX (805) 5254I72 FAX (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 /> K HITE Feld CM YELLOW Pmjcct 0qn —PINK tzbt+nuxy GT) <br /> { <br /> �p <br />