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i i+ i <br /> FGL ENVIRONMENTAL CHAIN-OF-CUSTODY RECORD LA PROJECCT <br /> (See Reverse for Instructions) NO V <br /> PROJECT NAME i Clieeeg Z SAMPLERS U K 'v Ve— SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> NT) DESCRIPTION CODES A Ground Water F Oil <br /> PROJECT NUMBER A 40 ml VOA Vial B surtace water G waste t Standard <br /> (SIGN) B Glass Liter E Brass Tube C Leachate H Bfanklspike 2 5 Day <br /> RECORDER C Plastic 500-m1 F Other D Rinseaie I Other 3 60 Hour <br /> —IV (SIGNI D Plastic Liter E SoillSediment 4 Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS e <br /> o AND <br /> Am zi PRESERVATION g <br /> SAMPLE <br /> Sm m o pu 7c x ¢m E' o"su <br /> °- NOTES ASSIGNED CONDITION <br /> Pat aS z a - BOTTLE UPON <br /> DATE TIME SAMPLE ID <br /> N~y LL " 2 NUMBERS RECEIPT NOTES <br /> t )6' , to so -- 3S X <br /> v 1 Iles <br /> -3 „ fro u <br /> ir <br /> NOTES 1 MISCELLANEOUS (Signature) y g } ' <br /> GC�p Uf Tc�f3fst C(�9T �►+� FbL eA Ished bRec d B I oat a Date A�ime,,,44 <br /> SAM ,B5 -{y & � OC4,M4,1 j DMCC06e41Br �CfCl/✓zc�J Y S.I�Ca �IS By Ignature) Rece.ed By (Signatur ) Date �4 - fir <br /> qul$ d By (Signature) Received By (SI ature) 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 /> Transport Container Transported with this <br /> Chain (by Serial No) <br /> Send Lab Results to (Name) k}e� L220 40A*A 015rA D[z S' riSB (Check Office Below) Verbals Requested Yes.K No ❑ <br /> ❑ SANTA PAULA ❑ STOCKTON ❑VISALIA <br /> TEL (805) 659-0910 TEL (209) 942-0181 TEL (209) 734-9473 <br /> FAX (805) 525-4172 FAX (209) 942-0423 FAX (209) 738-6273 <br /> IRONMENTAL LABORATORY • 2500 STAGECOACH ROAD • STOCKTON, CA 95215 • TEL (209) 942-0181 a FAX (209) 942-0423 <br /> RUI&k! <br /> WHITE Frcid Copy YELI OW Protect Cop) PINK Laboratory Copy <br /> r <br />