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0 <br /> FGL ENVIRONMENTAL CAN-OF-CUSTODY RECORD & PROJECT <br /> A/Ye', oc'tir'rs (See Reverse for Instructions) _ NO <br /> PROJECT NAME SAMPLEFS_ t� t � SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> / DESCRIPTION CODES A Ground Water F Oil - <br /> PROJECT NUMBER �/ �= Z A 40 ml VOA Vial �� B Surface Water G Waste t Standard <br /> f'J - �"� (SIGN} B Glass Liter �Tv C Leachate H BlanklSprke 2 <br /> AECQRDE / �--e C Plastic 500 ml P"'TTTTTTOther D Rm at I Giber 3 60 Hour <br /> H {SIGN} D Plast,c Lner E SoillSedfinen 4 Other <br /> NUMBER OF ANAL-)SIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> AND " $ <br /> m ae PRESERVAT]ON $ 1 ffig" _ g @Y a <br /> y8 m "� �C _ e a sm SAMPLE <br /> r; 9 3 V, �m o"oQ NOTES ASSIGNED CONDITION <br /> E= o Y` h E > BOTTLE UPON <br /> DATE TIME SAMPLE ID HCQN z NUMBERS RECEIPT NOTES <br /> j t4 <br /> i lfr 1-3 � 4 <br /> W 5113 At1 ' <br /> 5 13 <br /> j . <br /> f <br /> I 't <br /> NOTES/� CELLA EOr,ie qutsfed by (S Received By (Signature) Dte< Time=# 1 Z�6?IIr. <br /> e6l ��3 Relinquished By (Signature Received By (Stgnature)f Date Time <br /> Relinquished By 5f-nature) Received By (Signature) Date Time <br /> Method of Shipment Description of Other Chains-Of-Custody Dispatched By (Signature) i Date Time Received for lab By (Signature) Date Time <br /> h'd l+�c% Transport Container Transported with this r r <br /> Chain (by Serial No) <br /> � r <br /> Send Lab Results to (Name) (Check Office Below) 'lVerbals Requested Yes ❑ No ❑ <br /> ❑ SANTA PAULA l iil�r ❑ STOCKTON ❑VISALIA <br /> TEL (805) 659-0910 ��Cr'+(�yp�jrJf�+jt c1�$ TEL (209) 942-0181 TEL (209) 734-9473 <br /> FAX (805) 525-4172 FAX (209) 942-0423 FAX (209) 738-6273 <br /> FGL ENVIRONMENTAL LABORA'T'ORY • 2500 STAGECOACH ROAD • STOCKTON, CA 95215 • TEL (209) 942-0181 • FAX (209) 942-0423 <br /> u HITE Er.Fd Copy 1 ELLOH Projeo 0,p, PINK Lit-ritar%(apf <br /> I <br />