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FGL ENVIRONMENTAL CN-OF-CUSTODY RECORD 0 PROJECT <br /> /� /L /� <br /> } (See Reverse for Instructions) NO <br /> PROJECT NAMEC44JI e9k1 C01�}P SAMPLERS U)t41 r. I-t6,1411 SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> (P 1 DESCRIPTION CODES A Ground water F Oil <br /> PROJECT NUMBER 506'24AW D A 40-ml VOA Veal B surface water G waste 1 SlandaLd <br /> SI NI B Glass inter E Brass Tape C Leachate H BfanklSplke 2 5 Day <br /> RECORDER C Plastic 500-mI F Other D Rrnseate I Other J our <br /> (SIGN) D Plastic Liter E SoWSodunent 4 Other <br /> NUMBER OF LYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> gg rs <br /> AND g <br /> a n fin PRESERVATION <br /> 8 Sib vmx Q8 z g g &Y <br /> d� s SAMPLE <br /> • `s NOTES ASSIGNED CONDITION <br /> E� - �• F °V BOTTLE UPON <br /> DATE <br /> � TIME SAMPLE ID § = NUMBERS RECEIPT NOTES <br /> 9( Z '58-2 01' f <br /> Qft' S -2 i'1 1 <br /> 09)S '5 - 2 ZG r <br /> o9i 2 31' <br /> ST3 -2 r 36,) <br /> D9St� - 2 /• <br /> la2o - z s-1,11 <br /> I!4 2-11Vil <br /> 3G' r <br /> NOTESIMISCELLANEOUSfu/N(� 7Z7' 0AN7Y6itJ CO2P n ul by { I re eived { ig lure) Date I Time <br /> /540 5WAA&j f.1. P, 9S2.oS //f� ti1,12c I��tS i4w; 2121 12,30 <br /> 617A65 dl" l2es'.-:x 1-0 WX4,J 14"HTev_ /�SSDL. R Isled By (Signature) FCeceltred Bygn ure) Date Time <br /> 2 *A 2.2,a j,p,afA 0IIPAVe '5AC ib <! 319Z i RiIflInclo <br /> hed By (Signature) lRecilved By {SI ature} 3 ate Time r <br /> Method of Shipment Description of Other Chains-Of Custody Dispatched By (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) i'1 t' /�/G - 9¢f 'LbC X72 — 3 (Check Office Below) Verbals Requested Yes ❑ No ❑ <br /> ❑ SANTA PAULA ❑ STOCKTON ❑VISALIA <br /> TEL (805) 559-0910 TEL (209) 942-0181 TEL (209) 734-9473 <br /> FAX (805) 525-4172 FAX (209) 942-0423 FAX (209) 738-5273 <br /> FGL ENVIRONMENTAL LABORATORY • 2500 STAGECOACH ROAD • STOCKTON, CA 95215 • TEL (209) 942-0181 • FAX (209) 942-0423 <br /> KHiTt fi,IJ Cupv ti FE LOw. Pnjcu C,p% PINK Lylw,nt+rrt C+mt 131993 <br />