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FGL ENVIRONMENTAL <br /> ANALYTICAL CHEMISTS <br /> CHAIN OF CUSTODY <br /> DATE: <br /> CLIENT: <br /> ADDRESS: a.. R 3.24 <br /> PHONE NUMBER- <br /> PROJECT NAME: <br /> PROJECT MANAGER: <br /> SAMPLERS: <br /> Sample Location Date Time Number of Tests Date <br /> Number Description Sampled Sampled Containers Required Needed b <br /> 2.2.4yV?— 9 55 2 — 4.0 121sim PM 1 [sriLOrTp+t <br /> iIt — 10 5 B '3 — 4.0 A N% <br /> 1t ! L 5B4 — 3S I <br /> 17— S B 4 — 40 <br /> — 1'6 SIBS -- 30 <br /> 4 S B S — �F35 <br /> -� n 42//,?/P9 6d rxJ <br /> e nqu s e ece ve y: V Date Time <br /> Relinquished y. Received By: Date me <br /> Relinquished y: Receive2 By: Date Time <br /> MAIN OFFICE- 853 CORPORATION STREET- Pa BOX 272 BRANCH OFFICE- 2500 STAGECOACH ROAD <br /> &LABORATORY SANTA PAULA.CALIFORNIA MUM &LABORATORY MCIC'ICJN.CALIFORNIA 95205 <br /> (8057 5253824-(MM 659.0410 CM 942-0181 <br /> FAX OW 525-4iT2 FAX CM 942-OW <br /> • <br />