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FGL ENVIRONMENTAL CAN-OF-CUSTODY RECORD !B PROJECT <br /> (See Reverse for Instructions) NO <br /> PROJECT NAME Ln �� SAMPLERS l)r �`/� r y SAMPLE CONTAINER SAMPLE DESCRIPTION CQDES TAT CODES <br /> (PRINT) / DESCRIPTION CODES A Ground Water F Oil <br /> PROJECT NUMBER T-rjc.�� 'ed {j 1�t ! A 40 mi VOA Vial -----a, B Surface Water G Waste 1 Standar <br /> ' f X {SIGN )T B Glass Liter E was,Tube\ C Leachate H BlanldSpike 2 5 Day <br /> RECORDER r �� .f�� L� C Plastic 500 m! F r 0 Rtnsgg I 011ier 3 60 Hour <br /> (SIGN) O Piaslrc Liter �SodlSedr n 4 Other <br /> NUMBER OF ANAWIS REOUESTED LABORATORY USE ONLY <br /> CONTAINERS p <br /> r AND <br /> .d <br /> `8 ng PRESERVATION a <br /> m o LLm �• �E°C ��_� SAMPLE <br /> E~ m°<� NOTES ASSIGNED CONDITION <br /> ES _ �+ - E °v BOTTLE UPON <br /> DATE TIME SAMPLE ID N r �_ 0 = NUMBERS RECEIPT NOTES <br /> 5e :t_� <br /> � t I <br /> 1d It I_ <br /> }i r/f/ <br /> �•/` <br /> y L <br /> NOTES/MISCELLANEOUS /� J ,� R1IIngut�,ied b /SigoAtare) Received By (Signature) Date Time <br /> f ! � `fI I fLY ! <br /> Relinquished By (Signal e) Received By (Signature_ --r Date Time <br /> 5-11162 Ali CA. 7�52-,O 7 Relinquished By (Signature) Received By (Signature) Date Time <br /> Method of Shipment Description of Other Chains Of Custody Dispatched By (Signature) Date Time Received for lab By (Signature) Date Time <br /> f / � - ,j Transport Container Transported with this <br /> t Chain (by Serial No) - - <br /> Send Lab Results to (Name) j4Aft, ' &C, (Check Office Below) Verbals Requested Yes ❑ No ❑ <br /> ❑ SANTA PAULA El 'STOCKTON ❑VISALIA <br /> TEL (805) 559-0910 .`fib ram i 4/ Ja 9�eZ5- 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 /> R HITE Fa)d Cop YFLLOW Pugtt=Car= PINK Ubormi-v C==pi <br />