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h*. (-y 1,— , U , 0 0 & <br /> FGL ENVIRONMENTAL CHAIN-OF-CUSTODY RECORD LAB`.J?R04ZCT <br /> ` `� (See Reverse for Instructions) NO <br /> ! <br /> PROJECT NAME fCLK' u 1'i7-1l SAMPLERS M P. N re SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> j` p R DESCRIPTION CODES A Ground Water F Oil <br /> PROJECT NUMBER cI Wa , t-� A 40 ml VOA Vial a SuOace Water G Waste 1 Standard <br /> (SIG NI B Glass Luer E Brass Tube C Leachate H SlanklSpike 2 5 Day <br /> RECORDER C Plastic 500 ml F Other D Rinseate I Other 3 60 Hour <br /> (SIGN) D Plastic Liler _ _ _ E SoillSediment _ _ _ 4 Other <br /> NUMBER OF AN IS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> AND <br /> ii <br /> PRESERVATION a i n <br /> �g �8 <br /> g= ;E¢ at o SAMPLE <br /> m E` NOTES ASSIGNED CONDITION <br /> Ee E" a x Z z E ° BOTTLE UPON <br /> AT TIME SAMPLE IDN c i N z NUMBERS RECEIPT NOTES <br /> t M _400- _MW— 1 _AA K <br /> NOTES!MISCELLANEOUS <br /> It qui d (SI Received By (Sign ture) Date 1 Time <br /> -2Aq 37 <br /> Rely quishe ey ( Ignature) ce ed y I na a ate Tinie <br /> IReltnqAhkill Signature) Rece ed By (Signature) Date Time <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) (Check Office Below) Verbals Requested Yes ❑ No ❑ <br /> ❑ SANTA PAULA ❑ S I'OCKTON ❑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 /> I,(.L IFNVIRONf11FN7AL LABORA70RY • 2500 SI'AGECOACIJ ROAD • SIO(.KTON, CA 95215 • TEL (209) 942-0181 • FAX (209) 942-0423 <br /> 14 FIIEF I"Id C,.Pa 1111 OV6 Prol-I C P, PINK I <br /> 1 <br />