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FGL ENVIRONMENTAL CHAIN-OF-CUSTODY RECORD LAB PROJECT <br /> (See Reverse for Instructions) NO. <br /> PROJECT NAME G£?A'ip10 4-04D5 SAMPLERS C i y CL RK _ SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> DESCRIPTION CODES A. Ground Water F. on <br /> (PRINT) t Standard <br /> A. 4Pml VOA Vial H. LeaCha Water G. Waste <br /> PROJECT NUMBER_— �� (SIGN) B. Glass Liter E. Lass Tube G. Leachate H. Blank/Spire 2. 5 Day <br /> -D� G Plastic Si]O-ml F.Other D. Rinseate I. Other-__ 3. fi0 Hour <br /> RECORDER O` - _ E Soil/Sediment 4. Other <br /> D. Plastic Lifer <br /> (SIGN) <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS a 8 <br /> AND <br /> g PRESERVATIONm •8 E v SAMPLE <br /> 38 gm LLm ( a� e: <br /> "`-'eNOTES ASSIGNED CONDITION <br /> i ° BOTTLE <br /> UPON <br /> ;" E= NUMBERS RECEIPT NOTES <br /> DATE TIME SAMPLE ID <br /> •30 G <br /> 1010 G -a � I <br /> 11:05 — 3 <br /> 14 P- <br /> W.7>5 <br /> -1k.35 — I <br /> 5. GP - <br /> b:3D - I <br /> 1'115 - <br /> Relinquished by: (Signature) Received By: (Signa ure) Date OTim <br /> NOTES I MISCELLANEOUS A KLy1� ,1..,., <br /> R lin ished y: ignature) vedBnature) Da a Time <br /> A� s 2-2?.1 /01 <br /> � <br /> Relinquished By: (Signature) Received By: (Signature) Date Time <br /> Method of Shipment Transport cpthontainer onofD her Ch Transported w-Custody Dispatched By: (Signature) late TTime Received for lab By: (Signature) Date Time <br /> Chain (by Serial No.) LL <br /> �o-r.' /2 93 0B3S� <br /> Send Lab Results to (Name): I eL� LJ JR (Check Office Below) Verbals Requested: Yes El No El <br /> El SANTA PAULA I% STOCKTON L1VISALIA <br /> TEL 734-9473 <br /> 209) <br /> TEL (805) 659-0910 TEL (209) 942-0181 FAX((09) 738-6273 <br /> FAX (805) 525-4172 FAX (209) 942-0423 <br /> FCL ENVIRONMENTAL LABORATORY • 2500 STAGECOACH ROAD • STOCKTON, CA 95215 • TEL.(209) 942-0181 • FAX (209) 942-0423 <br /> N'HEE. Field Copy YELLOW.Prnjcat Gips PINK'. LaMnaon("ups <br />