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FGL ENVIRONMENTAL C N-OF-CUSTODY RECORD <br /> PROJECT <br /> (See Reverse for Instructions) NO. <br /> PROJECT NAME �- SAMPLERS w' ur SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> J Ra F�f DESCRIPTION CODES A Ground water F 011 <br /> PROUEGT NUMBER !'+h ALU r' A 46mf VOA Vial B Surface Water G waste t sranaard <br /> / 8 Glass Liter E Brass Tule C Leachate H Blank/Spike <br /> a C Plastic$00•ml F Other D Rinseate I Other 3 60 Hour <br /> RECORDER `� / D Plasti Liter E SaVSedkneni 4 Other <br /> (SIGN) <br /> t NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> AND <br /> io PRESERVATION Y B8 1 1 <br /> �Y n <br /> _FF 9� SAMPLE <br /> 8 �8 O 4Y yr 5 ¢ S <br /> "�<� NOTES ASSIGNED CONDITION <br /> BOTTLE UPON <br /> DATE TIME SAMPLE ID `�-H NUMBERS RECEIPT NOTES <br /> I <br /> I <br /> _ f Relinquished by-(Signature) Recetved By (Signature) ,- Date Time <br /> NOTES!MISCELLANEOUS 1+ /, y / j r <br /> f'z <br /> / l 13etmqulshed By (Signature) Received By (Signature)` Date Time <br /> Relinquished By (Signature) Received By (Signature) Date Time <br /> 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 /> l, Chain(by Serial No) <br /> r <br /> Send Lab Results to {Name) 1 �► r � ' - ) 7 �' ' !- �',,' t ��►' st ' `(Check Office Below) Verbals Requested Yes El No El <br /> El PAULA {! ` ° Z- + ❑ 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 • SfOCKTON, CA 95215 • TEL(249) 942-6181 • FAX (209) 942-0423 <br /> WHITE Fickf Copy YELLOW Pmyw Gip% PINK Laboratory Copy <br />