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• • i <br /> FGL ENVIRONMENTAL CHAIN-OF-CUSTODY RECORD LAB PROJECT <br /> .I {j (See Reverse for Instructions) NO <br /> PROJECT NAME CA� 1 fe C (00 f2i SAMPLERS W I!�AilkY t1 sit SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> PROJECT NUMBER S�fAuJ!�d�� � �f( IN ) DESCRIPTION CODES A Ground Water F Oil <br /> W A 40 ml VOA Vial B Surface Water G Waste 1 Standard <br /> 1 Ni B Glass Liter E Brass Tube C Leachate H Btank,Spike 1—2--5 Pay <br /> RECORDER r/�/_ y C Plastic 500-mi F Other_ D Rmseate 1 Other our <br /> (SIGN) 0 Plastic Liter E Soil/Sedtment 4 Other <br /> NUMBER OF LYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS u <br /> B o AND Q o q a lIw <br /> q— PRESERVATION $= v" <br /> �$ � SAMPLE <br /> m VI ¢ a m m <br /> NOTES ASSIGNED CONDITION <br /> z LL �a s n ° BOTTLE UPON <br /> DATE <br /> TIME SAMPLE ID N N z NUMBERS RECEIPT NOTES <br /> • , t3 l4zs - C r ! <br /> Irs <br /> r <br /> i�► Sr Z 6 ' <br /> ,5 3� <br /> 535 <br /> �5 3 4-6 ILI <br /> NOTES I MISCELLANEOUS N G TCS 04h 125 010 cdep Itng ed b S nature) erved y {Sr nature) i Date r e <br /> �soo S A� 2A 5'�0 1C 9 9soz0sri, <br /> �� ec A N��, �Ilq IS D <br /> �O 1. p/- /W r�su� t!/"" `1kyr/4 SG SdIs By ignature) wed y gnat ) Date Time <br /> 2�zo 4-1"C4(ft y�. D rr u•e , 57A7D 4 5-Dz'�� <br /> Rehnqul t <br /> d By (Signature) ecelve By (Sig ure) Date Time <br /> Method of Shipment Description of Other Chains-Of-Custody Dispatched By (Signature) Date Tlme Received for lab By (Signature) Date Time <br /> Transport Container Transported with this <br /> Chain (by Serial No) <br /> Send Lab Results to (Name) 9 - cr9/ %ASC 9/6 -F72-1693 (Check Office Below) Verbals Requested Yes ❑ No ❑ <br /> ❑ 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 a 2500 STAGECOACH ROAD e STOCKTON, CA 95215 a TEL (209) 942-0181 a FAX (209) 942-0423 <br /> NHITE FKIJ G,p% \ELLO% Pngw Ci,p� PINK Uhuratom Gqn RGC@VED F L Q 1 3 1993 <br />