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Z�rl` �rbWM15 <br /> � '� LAB PROJECT <br /> FGL ENVIRONMENTAL CHAIN-OF-CUSTODY RECORD No. <br /> j� n `� See Reverse for Instructions) <br /> PROJECT NAME 1��I �/IA"C- 9- SAMPLERS SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> -� (P I TI DESCRIPTION CODES A Ground water F at <br /> P NUMBER S A 40-ml VOA Vial B Surface water G waste 1 Standard <br /> 1 t N B Glass War E Brass Tube C Leachate H Blank/Spike 2 5 Day <br /> C Plastic 500-ml r ata l Oilier 3 O Hour <br /> '4I1 Ip -TL`— RECORDER D Plastic Liter E irnent 4 Ol+�r <br /> (SIGN) <br /> NUMBER OF #AYSIS REQUESTED LABORATORY USE ONLY <br /> jJ CONTAINERS $ � <br /> AND $^ � <br /> E7 ;i S PRESERVATION <br /> SAMPLE <br /> aNOTES ASSIGNED CONDITION <br /> E ° BOTTLE UPON <br /> s° s Alli 7 NUMBERS RECEIPT NOTES <br /> D E TIME SAMPLE ID ' <br /> a � <br /> /r <br /> r <br /> I <br /> NOTES I MISCELLANEOUS ac �) elln shed byf(Signature) Rece y (Signature) to Tirrre <br /> c ! � � tJ ��«'�r°'' /" 'u�, Relinquished By (Signature) y (Signature) l)ate Time <br /> rr r e-�a7p� Cr/ <br /> }J a � �fsV/117 Relinquished By (Signature) Received By (Signature) Date Time <br /> S,LtiI�F T/�J ail �/li�.s� <br /> Meth d of Shipment Description of Other Chains-Of Custody Dispatched By (Slgnature) Date Time Received for lab By (Slgnature) Date Time <br /> P�. T`O 6495nt�r Transported with this <br /> jC <br /> y„1,61- vc'i c"f/ Chain(by Serial No) <br /> Send Lab Results to (Name) (Check Office Below) Verbals Requested Yes ❑ No El <br /> ElSANTA PAULA & STOCKTON El TE <br /> TEL (805) 659-0910 TEL (209) 942-0181 TFELL ((2209) 734-9473 <br /> FAX (805) 525-4172 FAX (209) 942-0423 FAX (209) 738-6273 <br /> EGL ENVIRONMENTAL LABORATORY • 2500 STAGECOACH ROAD • STOCKTON, CA 95215 • TEL (209} 942-0181 • FAX (209) 942-0423 <br /> WHITE Field Copy YELLOW Proleci CApy PINK Laboratory Ci+py <br />