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Emb F mob <br /> FGL ENVIRONMENTAL CHAIN-OF-CUS �EC�RD LAB PROJECT <br /> j1J(See Reverse for Instructions) NO <br /> t leo T 1 i0)-e- SAMPLERS 1 r T 10 E"( r <br /> PROTECT NAME SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> (PR T) DESCRIPTION CODES A Ground Water F Oil ` <br /> PROJECT NUMBER r r -��1 1C A 40-m1 VOA Vial B Surface Water G waste 1 Siandard-- <br /> IGN) B Glass Liter E Brass Tube C Leachate H SlanluSpike 2 5 Day <br /> RECORDER I v L" C Plastic 500-ml F Other O Rinseate I Other 3 60 Hour <br /> J (SIGN) D Plastic Liter E Sotl/Sediment 4 Other <br /> NUMBER of - NALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS N C'] pp e <br /> ` f <br /> AND ia] �1 c <br /> o if m <br /> �o am PRESERVATION <br /> 8= SAMPLE <br /> E' NOTES ASSIGNED CONDITION <br /> E� a- _ !b �- T -1 �m E o- BOTTLE UPON <br /> DATE TIME SAMPLE ID N !t 4 t! I^ N z NUMBERS RECEIPT NOTES <br /> l al j3-4 <br /> Zk XI xI c r <br /> �o S 13 - <br /> 03,30 5- <br /> 2 6 C(0-^ i (-1 12 <br /> Of45 `f i 2- F // rJ f JC L' ` i !,t ^4 <br /> I olo t;ij ;'_ �tZG ' r �' Y Y` } f {C{ <br /> /d,"> r J 'e <br /> t 11.95 7 -2 3�. 1 r X �� _'(ra r'!r✓ <br /> NOTES l MISCELUWEOUS 11 r - el n s ed b (Signature Received B (Signature) Date 1`tme' <br /> 'I �7,e/�ri - �U �� f�lrf J ^ � i.r � ate ) q � x ff ) y ( s ) <br /> 523 Z �rr-rPocc`k rzag > 477- 3 7 <br /> by (d," / lj6 �et oui6hed By ( gnature) Received By (Signature) Date Time <br /> Z 20 tReUnquished By (Signature) Received By (Signature) Date Time <br /> Method of Shipment Description of Other Chains-Of-Custody Dispatched By (Signature) Date Time Received for tab By (Signature) Date Time <br /> _Transport,Container Transported with this <br /> C A R Chain (by Serial No) <br /> r <br /> Send Lab Results to (Name) n i:72-1 G 3' (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 a TEL(209) 942-0181 • FAX (209) 942-0423 <br /> WHITE Ficld C(py YELLOW Pn)jcct Capt PINK Laboratory Copy <br />