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• • . <br /> FGL ENVIRONMENTAL CHAIN-OF-CUSTODY RECORD LABB ROJECT <br /> (See Rev=erse for Instructions) NO '` / ' <br /> PROJECT NAME —L (� SAMPLERSt4-�,ee+s ��Cd, �i<l� SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> (PWNTl DESCRIPTION CODES A Ground Water F oil <br /> PROJECT NUMBER <br /> A 40 ml VOA Vial a Surface Water G Waste 1 Standard <br /> (SIGN) B G#ass Liter E Brass Tube C Leachate H Bfank/Spike 2 5 Day <br /> RECORDER C Plastic 500 ml F Other D Rinseate 1 Other 3 64 Hour <br /> (SIGN) D Plastic Liter E SodlSedimenl 4 Other _ <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS u <br /> `o AND c a $ <br /> wm g^ PRESERVATION $ sg o a a A n <br /> = SY a- <br /> Eg „8 mLL F¢ _ SAMPLE <br /> aF m Z m" a m NOTES ASSIGNED CONDITION <br /> E° x - °V BOTTLE UPON <br /> N N <br /> DATE TIME SAMPLE ID a <br /> N Z NUMBERS RECEIPT NOTES <br /> If <br /> Gp C 6C.3 t1,i CL, <br /> NOTES 1 MISCELLANEOUS Relinquished by (Sign�t ) Recdsved By (So nature) Date Tome <br /> _, L , <br /> Relsnqulshed By I nature) eoeived1W7Signature) Date Time <br /> Ra nquished By (Si Katur ) Received By (Signature) Date Time <br /> Method of Shipment Description of Othef Challis Of Custody Dispatched By (Signature) DateTsme Received for lab By (Signature) Date Time <br /> Transport Container Transported with this r <br /> Chain (by Serial No) <br /> Send Lab Results to (Name) (Check Office Below) Verbals Requested Yes ❑ No ❑ <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) 738-6273 <br /> FGL ENVIRONMENTAL LABORATORY • 2500 STAGECOACH ROAD + STOCKTON, CA 95215 • TEL (209) 942-0181 • FAX (209) 942-0423 <br /> R Illl l t acid Copy r Ft I ow Pn jcrr CnPS I'M LdWraiury Cup) <br />