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i <br /> PROJECT <br /> ENVIRONMENTAL CAN-OF-CUSTODY RECORD <br /> FGL ENVIRO No <br /> (See Reverse for Instructions) <br /> 0 SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> PROJECT NAME /r t <br /> SAMPLERS f f r DESCRIPTION CODES A Ground water F Oil <br /> 7 ( (P }/ /� r 1 Standard <br /> r r I l �(.Nv! A 40 ml VOA Vial B Surface water G Waste <br /> PROJECT NUMBER B Glass Liter E Brass Tube C Leachate H BlanklSpike 2 5 Day <br /> I NI D Rmseate I Other 3 60 Hour <br /> 7•�/ `r C Plastic 500 ml F Other 4 Other <br /> RECORDER �. !✓a�L f D Plastic Liter E SodlSed meM <br /> (SIGN) LABORATORY USE ONLY <br /> NUMBER OF ANALYSIS REQUESTED <br /> CONTAINERS <br /> L3 $ u <br /> c AND m m a n <br /> iim PRESERVATION �_ �$ x g m m mx SAMPLE <br /> id a Y E°a of mm <br /> ?m EP aU o= NOTES ASSIGNED CONDITION <br /> s= m BOTTLE UPON NOTES <br /> Em E— a = "— ~ , = NUMBERS RECEIPT <br /> DATE TIME <br /> SAMPLE ID <br /> 0All 0 ? ` t <br /> r � <br /> Rec ed B SI nature Date Tlme <br /> r .F #3ell �t7edl), {Signature) r y ( i ) <br /> NgTES I MISCELJ_4NEOU5 � `1 ' G� rt`�r 4 <br /> i�_r /rr date Time <br /> t�R'`r �vr� 1 r! '" f, 'f��•* /k 1,R�Ilrtqutshed By (Signature) eceived By (Signature) <br /> r rrs il�f,t�tfi / <br /> Rehngshed By {Signature) Received By (Signature) <br /> Date Time <br /> w <br /> Date Time Received for lab By (Signature) Date Time <br /> Method of Shipment Descnptlon of Other Chains-Of Custody Dispatched By (Signature) <br /> Transport Container Transported with this <br /> Chain (by Serial No) <br /> - r A-Ila <f /5_325_ (Check Office Below) Verbais Requested Yes Q No El <br /> Send Lab Results to (Name) ElVISALIA <br /> El SANTA PAULA ❑ STOCKTON TEL (209) 734-9473 <br /> TEL (805) 659-0910 TEL (209) 942-0181 FAX (209) 738-6273 <br /> FAX (805) 525-4172 FAX (209) 942-0423 <br /> FGL ENVIRONMENTAL LABORATORY • Z500 STAGECOACH ROAD • STOCKTON, CA 95215 • TEL (209) 942-0181 • FAX (209) 942-0423 <br /> 4�HITE F,eid Cop, lELI OA Prnteci CoPt PINK LibmatorN CopY <br />