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FGL ENVIRONMENTAL CHAIN-OF-CUSTODY RECORD NO LAB PROJECT <br /> ,,/, r w�l r �. 1 ,r , ti f (See Reverse for Instructions) TA <br /> �(,yF�t�� Lr f s�J f'fC tr)'�r SAMPLE CONTAINER SAMPLE DESCRIPTION CODES <br /> SAMPLETAT CODES <br /> PROJECT NAME RS <br /> A Ground Water F O <br /> p DESCRIPTION CODES <br /> A aD ml VOA Vial B Surface Water G Waste t Standard <br /> PROJECT NUMBER SlV'N) B Glass Liter E Brass Tube C Leachate H BlanklSplke 2 5 Day <br /> E i fri 1 C Plastic 500 ml F Other D Rinseale I Other 3 6D Hour <br /> RECORDER f D Plastic Ller E SoilfSedintenl a Other <br /> > (SIGN) <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> AND d._ S � a m <br /> _-- n-- PRESERVATION �i♦ � �$ _ g $�ay5NOTES <br /> SAMPLE <br /> n <br /> �� �' �I V a� SIGNEDCONDITION' OTTLE UPONDATE TIMESAMPLE !DE— _ , UMBERS RECEIPT NOTES <br /> l 7 <br /> J + <br /> NOTES 1 MISCELLANEOUS lin t�hed byf(Signature) Rf ived By (Signature) ate Time <br /> t +�✓r ,n -Jt �G=,1�/_/ Date Time <br /> CelYed B <br /> S6 nqulshed By (Signature) — y (Signature) <br /> ) <br /> Relinquished By (Signature) Received By (Signature) Date �jTqimeMethod of Shipment Descriptionateptton of Other Chains Ot Custody Dispatched 8y (Signature) DTimaReceived far iab By (Signature) Date T <br /> Transport Container Transported with this <br /> Chain (by Serial No) <br /> I <br /> J (Check Office Below) Verbals Requested Yes [ No El <br /> Send Lab Results to (Name) <br /> ❑ SANTA PAULA ElTEL (2 STOCKTON ❑ A <br /> TEL (805) 659-0910 TEL (209) 942-0181 TEL (209} 734-9473 <br /> 1 <br /> FAX FAX (209) 942-0423 <br /> AX (805} 525-4172 FAX (209) 738-6273 <br /> FGL ENVIRONMENTAL LABORATORY • 2500 STAGECOACH ROAD • STOCKTUN, CA 95215 • TEL (209) 942-0181 • l AX (209) 942-0423 <br /> WHI r£ k0d Cop! 1 FI LOW Prulcci Cvpti PINK "N,7dtnry Ceps . <br /> S � f JJ J) � j -_; �! r -7/ Y _Jl; , �}1 •� i r_l_ J � � <br />