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IeT <br /> '� � FGL ENVIWNMENTAL CHA N-OF-CUSTODY RECORD B PAOJ cr <br /> )9t jl�— <br /> ' (See Reverse for Instructions) NO <br /> PR ECT AM£ 1< I SAMPLERS 44 SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> C (PRIN <br /> DESCRIFf?ION CODES A Ground water F Oil <br /> PROJECT NUMBER x. ! A 40�ml VOA Vial. B Surface water G waste 1 slandard <br /> ( (SIGN) B Gins Liter E E morass Tube C Leachate H BlanVSpike 2 5 Day s <br /> R1=avORDER C Plastic 5N-mm Other D Rinseale I Other 3 W"our <br /> ( ! D Plastic Liter IfSediment 4 Ottw <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE 1PNLY <br /> CONTAINERS <br /> AND <br /> m PRESERVATIOAk E a # __ <br /> ! LL = SAMPLE <br /> m �t-k"" a a€ g =_ �; � -S NOTES ASSIGNED CONDITION <br /> 1 E— E" I E 0— BOTTLE UPON <br /> DA TIME SAMPLE ID f � = NUMBERS RECEIPT NOTES <br /> of IW'U <br /> i S <br /> *00 <br /> fr i i l f <br /> V <br /> A4W ' RVida <br /> i <br /> NOTES/MISCELLANEOUS Ren sh ( n e} Race d By (Signature) pate I Time <br /> oZ � f 6 a <br /> Rehnqumsh By (Signature) 4AABI6d By (Signature - Date Time <br /> t'Yh Relinqumshed By (Signature) Received By (Signature) Date Tinge o <br /> Method of Shipment Description of Other Chains-Of-Custody Dispatched By (Signature) Date Tlme Received for fab By (Signature) Date Time- <br /> Transport Container Transported with this <br /> Chain(by Serial No) <br /> I <br /> Send Lab Results to (Name) < �S! I(Check Office Below) Verbals Requested Yes ❑ No ❑ <br /> ❑ SANTA PAULA C�A i1�,P4�t <br /> s� ������ �STOCKTON ❑VISALIA <br /> TEL (805) 659-0910 .� r 4EL (209) 942-0181 TEI (209) 734A473 <br /> FAX (805) 525-4172 —k,%1A - FAX (209) 942-0423 FAX (209) 738-6273 <br /> FGL ENVIRONMENTAL LABORATORY • 2500 STAGECOACH ROAD • SI`OCKTON, CA 95215 • TEL (209) 942-0181 • FAX (209) 942-0423 <br /> CA 1 -,� f d uU yf W4iliL Fic1A Copy YrLLOW Profen Grp PINK LzbW st y Copy <br /> I t f� -T Jy !`r <br />