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i <br /> I <br /> S <br /> FGL ENVIRON1VMNTAL CHA!N-GF-CUSTODY RECORD LarS'PRoJ1=cT <br /> lS' everse far Instructions) ter'• <br /> .J /�'( .' SAMPLE CONTAIN!R SAMPLE DESCRIPTION CODE S TAT CODES <br /> PROJECT NAME SAFIIPLERS <br /> IN DESCRIPTION CODES A r„ou�awaen or <br /> J + 47 <br /> A 40 m1 VEA V,al I - Su,race VJate, G WW , S++---•� <br /> PROJECT NUMBER_ /..-._.�_�/�_ f roNl -� '� I - e I <br /> B Glass trte. E f3•a� fR C ' a[h— H BlanklSpik. 2 Ca• <br /> RECORDER � t<.rL r_— c vlxvr c 50-1 F.01h.-.- _.___ o insealx i em _._.. ] Otho,H, + <br /> (SIGN- D L'In54ic Tlre+ .. _.. E SeilrSedim?nS ..._.____ A.Omor <br /> NUMBEiT of ANALYSIS REO_UuSTED fI LABORATORY USE ONLY <br /> § <br /> AND z_ <br /> 5— FRE5f.R.ATIGN B � I I X L <br /> "BI98 s I c� I t of> SAMPLE <br /> NOTES ASSIGNEE } CONDITION <br /> z BOTTLE If UPON <br /> LIME SAMPLE ID r NUMBERS RECEIPT NOTES <br /> L t rE„•=�tJT t a L - —EE — <br /> I <br /> _ I <br /> NOTES l MISCELLANEOUS Ali gUis yAature) R ceiued By:isignature) Date;Time <br /> Re inquisned By:(Signature) �I eceived By:tSignature) Date Time <br /> Relinquished By:(Signature) Received By:(Signature) — Dale Time <br /> Method of Shipment T Description of Otner Chains-OI•Custody Dispatched By:(Signature) Date Time Received for tab Bye(Signature! Date Time <br /> Transport Container ��Trans orfed with this <br /> p 1 Cha7thy Serial No.) <br /> F _(Check Office Below) Verbals 116quested: Yes El 0 <br /> Send Lab results to (Name): LC CACI <br /> ❑ SANTA PAULA � f � 9 'TOCKTON ❑VISALIA <br /> TEL(805)559-0910 TEL (209)942-0181 TEL(209) 731-9473 I <br /> iAn 1605)525-4172 FAX (209)942-0423 FAX (209) 738 O?73 <br /> FGL ENVIRONMENTAL LABORATORV 2500 51'AGFCOACII ROAD•STOCKTON,CA 95215 •TEL.(249) 942-4181 • FAX (249)942-4423 `I <br /> "MV:o,•Id C,r•1 YELL OW Nn,r«,Ci-r, PI%X tar.,.+I„y c„rti <br /> I <br />