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FGL ENVIRONMENTAL CERN-OF-CUSTODY RECORD 0 PROJECT <br /> (See Reverse for Instructions) NO <br /> PROJECT NAME SAMPLERS f /� f SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> (P N DESCRIPTION CODES A Ground water F Oct <br /> A 40-ml VOA Vial B surface water G waste I_Standard } <br /> PROJECT NUMBER - — <br /> (SIGN) 8 Glass Liter E Brass Tube C Leachate H Blank/Spike 2 5 Day <br /> C Plastic 500-mi F Other O Rmseate I other 3 60 Hour <br /> RECORDER 01 l #e D Plastic Liter E Sod/Sediment 4 Other. <br /> (SIGN) <br /> l (oZlS 'S�+cT t +� r D r NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> TO yr (3 <br /> L CONTAINERS <br /> S4Mle4-M` rA AND <br /> PRESERVATION IY $ SAMPLE <br /> 5Y <br /> p So r € m NOTES ASSIGNED CONDITION <br /> °� BOTTLE UPON <br /> E� , a <br /> r DATE TIME SAMPLE ID �' 5 ` 4 z° I NUMBERS RECEIPT NOTES <br /> 1-17- lf74ti —� f Ct Utr� r/ c4� <br /> loso 7/5 -1 2G <br /> } !Ilan <br /> 1 <br /> 4�104 <br /> j _r 5' <br /> " 1 <br /> NOTES/MISCELLANEOUS 1111"6 Tp. 091tolle �l/� ?Reh q Ished.b Signature) Received By (Signature) Date Time <br /> 344 of Zwjure.v64-rte lVu //.�Al19")5, CAr i�56cc r1 <br /> A rTN PC{t✓ A-Wt to uished By (Signature) Received By (Slgnatur Date Time <br /> Relinquished 8y ature) Rece By (Signature) Date Time <br /> Method of Shipment Descnption of Other Chains-Of-Custody Dispatched By (Signature) Date Time Received for lab By (Signature) Date Time <br /> Tran ort Container Transported with this <br /> Chain (by Serial No) 1 <br /> Send Lab Results to (Name) i' 270 4oYvoI r "G7 �� (Check Office Below) V Q'is Requested Yes ❑ No ❑ <br /> ❑ SANTA PAULA y�G r�7?"7q4' ❑ 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 /> WHITE Field Copy YELLOW Pmtert Cnp% PINK Laboratory C,yg <br /> 1 <br />