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FGL ENVIRONMENTAL CHAIN-OF-CUSTODY RECORD LAti PRaJECT <br /> (See Rt,erre for Instructions) NO.— <br /> PROJECT NAME 7-11' SAMPLERS SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODLS <br /> / t ({f� i NT DESCRIPTION CODES A.G,ound WA1er F.QI <br /> /• 1.11. — A 40m1 YOA Via B.Surla[A W,ster G.Wa+1a 1 $Tanoarcs <br /> [ LLL..��� 57 <br /> - l$IGfll 8 GIam Lger E Brass Tuba C Leachate " eIP klq[i.e 2 5 tlry <br /> PROJECT NUM RECORDER 4%�_.�_ �'4-'' C rites Sao m1 F other_ r n wale I uu er ___ 7 ra H.W <br /> ----- 0 P1W.0 Ut•r ----------- E S01ASed­Tkt _ _.._. 4 Other - <br /> . NUMaEn OF ANALYSIS REOUESTED LABORATORY USE ONLY <br /> CONTAINER$ <br /> L AfiD �. y i <br /> 5 <br /> FAESErNATIGN <br /> Y E `ti ( g € ylak SAMPLE <br /> �: �p {� ,S Y E- r"�� NOTES AS <br /> CONDITION <br /> Lk eu u s' $ c BOTTLE UPON <br /> a <br /> DATE, TIME SAMPLE Ip " NUMBERS RECEIPT NOTES <br /> tu _ r .0 <br /> f _ i f �, I E ---- — -- - <br /> NOTES IMISCELLANE US 1 1 �r Etell Ishe y: 51 naturey — '• Sign3lure) DatR Time <br /> Relinquisyeti By:(Signature) fii ceived By:(Stgnasure} late dime ,— <br /> Pf� _ <br /> Relinquished By:(Signature) Received By:(Signature) Oate Time <br /> I <br /> Method of Shipment Description of Other Chains•Of-Custody Dispatched By:(Signature) Date Time 1 Received for fab 6y:{Signature) Date I Time <br /> Transport Container Transported with this <br /> Chain(by Serial No.) ----- <br /> Send Lab Results to(Name): f �` !n` (Check Office Below) VerbaEs Requested:Yes No ❑ <br /> ❑ SANTA PAULA + A�� STOCKTON LIVISALIA <br /> TEL(80 5) 659-0910 t dK '2tXX]-4 e fy TEL(209) 942-0181 TEL(209) 734-9473 <br /> FAX(805) 525-4172 JC /.,o t4[�8�, y FAX (209) 942-0423 FAX (209) 738-6273 <br /> FCL ENVIRONI NIENTAI,LABORATORY •2500 s,rAGECOACII ROAD• SI'OCKTON,CA 95215•TEL.(2Wt 942-0181 • FAX (209)942-0423 <br /> 'A 11StIi l+rlo C"P, t'r.I 10%%:Prnjru Cnr) PINK L.NP —(„p, <br />