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y FGL ENVIRONMENTAL CHAIN-OF-CUSTODY RECORD L B PROJECT <br /> ! (See Reverse for Instructions) f�a - ZpS/ NO. I SO351 <br /> PROJECT NAME L.f)�„, iJ 1�-�i'e ! />� SAMPLERS _ __ -� SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> (PRINT) DESCRIPTION CODES A Ground Water F On <br /> PROJECT NUMBER _ _ �_ A 4Dml VOA Vial B Surface Water G Wade I sl.ru,tad <br /> 7J // ,SIGN) B Glass Liter E Brass Tube C Leachate H Blank/Spike 2 5 Day <br /> RECORDER /a ` _ - C Plastic 500m1 F Other O Rmseate I Other 3 BO Than <br /> -SIGN) u ' D Plastic Lite, E SallSeJmrenl 4 Otlmr <br /> o. <br /> NIIIABER OF 14NALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> v 5 AND <br /> PRESEflVArION :_ '- 9 is <br /> E➢l m�I m=F i2 SAMPLE <br /> F' sU aU NOTES ASSIGNED CONDITION <br /> E BOTTLE UPON <br /> ATE TIME SAMPLE ID ? NUMBERS RECEIPT NOTES <br /> 1_ /2po M I r N N ✓ _ ✓ r _� <br /> L - - ✓ - --- - __ <br /> - - - - Ale - <br /> I � Al 1. - 13 0 y ✓ � <br /> NOTES/MISCELLANEOUSLRelin uis (Signature) --- -- - <br /> � y. Received+By: (Signature) ,Dal � Time <br /> a4 � gnafture) Dzac e �T�i` SSga//V1;,Q HCA- k.b <br /> /- ?,14v /0:J d <br /> — -e -- e <br /> el' q had By: (Signature) Received By.-(Signature) Date Time <br /> Method of Shipment Description ai Other Chains- with <br /> Dispatch : (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) a bats Requested: Yes D No ❑ <br /> SANTA PAULA .' El 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 ENVIRONAIENTAL LABORATORY • 2500 STAGECOACH ROAD • STOCKTON, CA 95215 • TEL.(209) 942-0181 • FAX (209) 942-0423 <br /> WHITT IieldCnpl YELLOW.Pmie1 Cup% PINK LaNeumq Cupr <br />