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FGL ENVIRONMENTAL CHAIN-OF-CUSTODY RECORD LAB PROJECT <br /> (See Reverse for Instructions) NO <br /> PROJECT NAME 0A4JrF1454J CG iZ P SAMPLERS �>�r A L< Gf SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> (P DESCRIPTION CODES A Ground Water F Ori <br /> PROJECT NUMBER 1-S�SEl du1�'°I� / WA 40-ml VOA Vial B Surface Water G waste rd <br /> Y/�r r (SIGN) 8 Glass Liter E Brass Tube C Leachate H BlanklSpike 2 5 Day <br /> C Plastic 500 ml F Other D Rinseate I Other our <br /> RECORDER (SIGN) D Plaslic Liter E SotllSediment 4 Other <br /> r <br /> NUMBER OF LYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS U <br /> AND <br /> c$ <br /> PRESERVATION =.� ay Y <br /> s- m SAMPLE <br /> m °ms o" eu _ E" m°o� NOTES ASSIGNED CONDITION <br /> E m V f E > BOTTLE UPON <br /> DATE TIME SAMPLE 1D �yy z NUMBERS RECEIPT NOTES <br /> r27 3 O51-4— �� Y t Z <br /> NOTES 1 MISCELLANEOUS /LL•/N qu ed b I n ure) Vceived ( Ig aIt re) D to Time <br /> 156V SyA 20,40, S-f�c�'tr�, t.4 3 1230 <br /> �j�Sl�l.l s'a/I P sh d By (Signature) a r ) Date Time <br /> L�Opi�s ar ..fid /LSU LIs yo - Wltf Aam� r 4SSZX. 2 22 0 R c ved By ri <br /> Rslinquf ed By (Signature) lRe Date Time <br /> (115rA 1? v, 5A4 ro qS&V—< <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) F2U G -W AX 71-/653 (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 • 2500 STAGECOACH ROAD + STOCKTON, CA 95215 • TEL (209) 942-0181 • FAX (209) 942-0423 <br /> KHITF Fidd Cop} y ELLOtti Pngc,t Cop, PINK Labnratory Copy RECEIVED F E B 1 3 1993 <br />