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FGL ENVIRONMENTAL CH -OF-CUSTODY RECORD PROJECT <br /> (See Reverse for Instructions) _-� NO <br /> PROJECT NAME � �1 Y� ��SAMRLEBS �1��'� �+ f SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> ' -`�``~� DESCRIPTION CODES A Ground water F oil <br /> PROJECT NUMB A 40-ml VOA Viat B Surface Water G Waste 1 Standard <br /> B Glass Liter E Brass Tube C Leachate H Blank/Spike 2 $Day <br /> �R^� fpr /f .!_ -y - ` —�s - stic 500-mi F Other D R nseate I Other 3 50 Hour <br /> r � � 1•M G�l7Jy�D�fr� f�-�- Y L (SIGN) �� �� ` _ �� �'�ta5t, iter E Soil/Sedimem 4 Other <br /> 11 <br /> N�UMBER OF ANALY$t$ REQUESTED-° , >� LABORATORY USE ONLY <br /> .yONTAINERS Q <br /> AND <br /> m— g— PRESERVATION $ m$ <br /> 5x8 ' LL� S= €€¢ 8� =r SAMPLE <br /> m o ao �' C, ¢� g m°a� NOTES ASSIGNED CONDITION <br /> `- E- E� _ LL �-Ct �m E "� BOTTLE UPON <br /> DATE TIME SAMPLE IID N .� y z NUMBERS RECEIPT NOTES <br /> / Z`J 1030 -�3 U 'ur <br /> f/M' �` - /Q ( CAl/ i f < <br /> X103 5 / - ZS <br /> !!la 56 1 <br /> C)6 so <r <br /> 0170 kt 1 Y / 61 t w <br /> IYA <br /> Ac <br /> -7?9 5 -) l i I - J '/ . "� V <br /> NOTES 1 MIS/CELLAN OUS ! 74dt" - H r t�2- R ! qws by (Signature) Received By (Signature) Date Time <br /> fj Z3 /7 I'+Ytf �JP, ` I �{iri l"L' `�JZ�� / o-'pYr 4?n-� 54-7 <br /> ys�r /r SSS . 2 ? Z-G Retlnqutshed By (Signature Received By (�na ure) Date Time <br /> k s 4 C. � r <br /> ]tri VF + \/ r-, tMr i 7 i + J�\ N <br /> Rellnqutshed_Byr(Signature) Received By (Signature) Date Time <br /> �;f/. l <br /> Method of Shipment Description of Other Chains-Of-Custody Dispatched By (Signature)' Date Tlme Received for lab By (Signature) Date Time <br /> Transport Container Transported with this <br /> L I- * < < t �s T` Chain (by Serial No ' <br /> Send Lab Results to (Name) ��� �� '� ' ��� �r<� (Check Office Below) i(ejals Requested Yes ❑ No ❑ <br /> ❑ SANTA PAULA c ( r t` r,, ❑ STOCKTON ❑VISALIA <br /> TEL (805) 659-09 10 TEL (209) 942-0181 TEL (209) 734-9473 <br /> FAX (805) 525-4172 FAX (209) 942-0423 FAX (209) 738-6273 <br /> f i ' <br /> FGL ENVIRONMENTAL LABORATORY 2500 STAGECOACH ROAD • STOCKTON, CA 95215 • TEL (209) 942-0181 • FAX 1209) 942-0423 <br /> NHITE Ficld Cop} YELLOW PmIcU Cup% PINK Laboratory Gip} -- <br /> I <br />