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fr-" 1--v r-11T r r-14 r--" r^",' r_T r_F rte' rr r_* <br /> FGL ENVIRONMENTAL CHAIN-OF-CUSTODY RECORD LAB PROJECT <br /> /�' .� (See Reverse for Instructions) . NO. <br /> –L?/j�:�' '/fes C . <br /> PROJECT NAME SA�1+lPLERS �• �C-� SAMPLE CONTAINER SAMPLE DESCRIPTION CODES <br /> TAT CODES <br /> C� RINT) r DESCRIPTION CODES A. Ground Water F. Oil <br /> PROJECT NUMBER A. 40 ml VOA Vial B. Surface water G. waste I. Standard <br /> Q f (SIGN) B an Liter Brass Tu 'C. Leachate H. BlankfSpirce 2. ay <br /> REC0RDE C C. Plas16ck04ml F.Other D a I. Other 3. 60 Hour <br /> (SIGN) O. Plastic Liler E. $aillSedimenl 4. Other <br /> NUMBER OF ANALYSIS REOUESTED LABORATORY USE ONLY <br /> CONTAINERS v <br /> m AND Y <br /> PRESERVATION 5^ <br /> 88]:) ]T SAMPLE <br /> NOTES ASSIGNED CONDITION <br /> e" BOTTLE UPON <br /> DATE TIME SAMPLE ID y z NUMBERS RECEIPT NOTES <br /> r dt <br /> Rr7 .7 S� k i <br /> D; <br /> I x' <br /> t t, FSE Q AIW I IM I It <br /> 06 F ' <br /> NOTES!MISCELLANEOUS �. �l...� ; Relinquished by: (Signature) Received By: (Signature) Date . Time <br /> '17`✓f�r� �I�t� wf=ftC-'•''C��� ..�G.-��� '<+'/r ' �'"¢.- �,'�r' - , <br /> r+• l^ A ! -tf- Relinquished By: (Signatu[�)r Received By:(Signature) Date' Time <br /> tt <� Relinquished By: (Signature) Received By: (Signature) fate Time <br /> ''� <br /> ethod f Shipm nt . Description of Other Chains -Custody Dispatche�By: (Signature) Date Time Received for lab By:(Signature) Date Time <br /> Transport Container Transported with this <br /> f ( � .f � r Chain (by Serial No.) <br /> ;trr�irrt�;S �. <br /> ref r. <br /> Send Lab Resu is to (Name): 7 l . =C- (Check Office Below) Verbals Requested: Yes ❑ No ❑ <br /> ❑ SANTA PAULA 42,Z"26 '--0/71Z Wt i'� f O STOCKTON ElVISALIA <br /> TEL (805) 659-0910 t;;rxi,;l jt a TEL (209) 942-0181 TEL (209) 734-9473 <br /> FAX (805) 525-4172 1e (`}`f+6 ?'f2, JW-f 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 /> WHITE-Field Copy YELLOW:Prujw CTPINK:Labnrmnry Copy <br /> F� <br />