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FGL ENVIRONMENTAL CMN-OF-CUSTODY RECORD 013 PROJECT <br /> f (See Reverse for Instructions) <br /> NO <br /> PROJECT NAME r � / � SAMPLERS (—{lir SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> "AM/yv5�j' r ' (PAt)4T) DESCRIPTION CODES A Ground Water F O! _ <br /> PROJECT NUMBER ! - r <br /> r t � 7 •mss- �.� A 40 ml VOA Via! a Surface Water G Waste Standard <br /> (SIGN) �� _ B Glass Lner Brass Tum- C Leachate H Blank/Spike 2 5 Oay <br /> RECORDER�,.!� �!r 1i r✓ffr°�,� rrt� Plastic 50D mf F Other <br /> D Rmse t_ I Other 3 60 Hour <br /> I C Plastic <br /> (SIGN) D Plastic LiterSodlSedimenZ 4 Other <br /> NUMBER OF 'NALIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS - <br /> U <br /> o AND r <br /> w - <br /> 5w - PRESEAVAPON $ ma 3 A n <br /> o- <br /> `c$ v$ E ma cm m` <br /> Sm om m o a� t m�= SAMPLE <br /> ME -°am m z a NOTES ASSIGNED CONDITION <br /> E- E"" o z �, .-- `� E BOTTLE UPON <br /> DATE TIME SAMPLE ID h y 1 N = NUMBERS RECEIPT NOTES <br /> 5 64-3 <br /> S6 4-5 t f <br /> e4— <br /> I <br /> NOTES 1 MISCELLANEWS , qERel ished (Si nature Received B SI natur <br /> 9 ) Y ( g e} Date Tlme <br /> 14 <br /> 746nx Rinquished By'( gnalure) Received By (Signature) Date Time <br /> C� ��) ' � �b Relinquished By (Signature) ReCewed 13y (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 /> ,,Me <br /> r velre'et' r Transport Container Transported with this <br /> Chain (by Serial NO) <br /> OX <br /> If <br /> Send Lab Results to (Name) �fr� te/ 1f5.SGC. <br /> { ) (Check Office Below) Verbals Requested Yes ❑ No ❑ <br /> ❑ SANTA PAULA 2 ZZd Lor-*3 lr r s Dr. ❑ STOCKTON ❑VISALIA <br /> TEL (805) 659-0910 �aC/ /9f�'�f����•`��82� 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 /> WHITE. Field Copv tFLLOK ProjP <br /> e G„ , PINK LJhnrauiryo <br /> Gpr <br /> f I <br /> I 1 ' <br />