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Pic 6-• <br /> FGL ENVIRONMENTAL CHAIN-OF-CUSTODY RECORD LAB PROQT <br /> (See Reverse for Instructions) N0.-2 <br /> PROJECT NAME Lf'i,kmlp fnOk5 '*kAMPLERS ("RAIcS c LdR9 SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> (PRINT) DESCRIPTION CODES A. Ground Water F. OII <br /> PROJECT NUMBER ' 7 A. 40 nnl VOA vial B. Sudacs Wale, G. waste I. Standard <br /> l'tSIGN) B. Blase Liter E. Brass Tube C. Leachate H. elanorSpike 2. 5 Day <br /> RECORDER r/( ` •`'"'^ l+ C. Plastic 506.1 F.Other D. Rinseate L Other 3. 60 Hour — <br /> D. Plastic Liter E. Soil/Sediment 4. Other — <br /> (BIGN) <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS = a_ <br /> 6 AND $_ <br /> €m ag—g PRESERVATION $ ai $ 3 <br /> LL% t Y- Eli 1E SAMPLE <br /> E `-' NOTES ASSIGNED CONDITION <br /> $m �aF z v 2i �- E �- BOTTLE UPON <br /> DATE TIME SAMPLE ID NUMBERS RECEIPT NOTES <br /> q io glL <br /> G — X I x <br /> � lou <br /> n 11 vS - 3 A X X 1 X <br /> 1455 P <br /> ( 14;35 I <br /> 5 G 10 <br /> t;" P. I <br /> nls - <br /> NOTES I MISCELLANEOUS .,•. inquished by: (Signature) 'Received By: (Signa ure) Date Time <br /> ((r. t 7.o'2.c �ft7 d t l iii Pt i'ti ItIJ4I L I <br /> R lin iisshed y,<Signature) F1QcAjvad B nature) Date Tima <br /> �e lw-A - 1//J�'7 7 <br /> linq ' d B : (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 /> Transport Container Transported with this <br /> Chain(by Serial No.) / <br /> Send Lab Results to (Name): (Check Office Below) V r Is Requested: Yes ❑ No ❑ <br /> El 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 /> FGL ENVIRONMENTAL LABORATORY • 2500 STAGECOACH ROAD • STOCKTON, CA 95215 • TEL.(209) 942-0181 • FAX (209) 942-0423 <br /> WHITE:Fuld Copy YELLOW:Pmjen 0, PINK. 1,bnrao,Co, <br />