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FGL ENVIRONMENTAL CAIN-OF-CUSTODY RECORD SkB PROJECT <br /> (See <br /> ..Reverse for Instructions) NO <br /> PROTECT NAME J' vC �P�n�, / SAMPLERS �^' f" r SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> (PI aTl , � DESCRIPTION CODES A. Ground Woler F Od <br /> PROJECT NUMBER r�lJ rxG4771 A. ao-,rA VGA vm s Surface water G wase , Sia xiara <br /> Li� �,(SIGN) B Glass Law E Gdv Tube C Eaacnafe N BlanklSpke 2 <br /> RECORDER �,L� , C Plastic SO4rtV F other D R"'eeaw L Dow 3.a W H <br /> ow <br /> IStfiNf o Plastic Liter _ E SowSadin+ent <br /> y er <br /> NUMBER OF ANALYSIS REQUESTED t A$ORATORY USE ONLY <br /> CONTAINERS <br /> s PRESEN <br /> AYATION I: 3 <br /> t�T5 $ a8 Y i 3 ax '2` SAMPLE <br /> �7 o ( 1 ¢� $ "' < NOTES ASSIGNED CONDITION <br /> aC = F BOTTLE UPON <br /> DATE TIME SAMPLE ID y z NUMBERS RECEIPT NOTES <br /> (� — ! i yC ` -A sib Uul•�u irnn��-r ti <br /> )hoo 5 W <br /> Y 5 <br /> r rain r <br /> 1 r t ! e t4�r-'r�, <br /> t <br /> NOTES!MISCELLANEOUS ��4/�G - uCC�!'Si t rI7'rfsi f �i i eL qu by f tire) Received By (Signature) Date I Ime <br /> L;O,C /-9 <br /> 4 f S 32 airllq Is By (Signature) Received By (Signature) Date Time <br /> ,4�A) .�flee 5'C1�5 f <br /> { Relinquished By (Slc)nature) Received By'-(Slgnature) Date Time <br /> Method of Shipment Descnphon of Other Chains-01-Custody Dispatched By (Signature Date Time Received for lab By (Signature) pate Time <br /> Transport Container Transported with this <br /> Chain(by Sena] NO) <br /> Send Lab Results to (Name) Wx UA er 7b (Check Office Below) Verbals)Requested: Yes ❑ No ❑ <br /> ❑ SANTA PAULA ❑ STOCKTON ❑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 /> FGL ENVIRONMENTAL LABORATORY • 2500 STAGECOACH ROAD • STOCKTON, CA 95215 • TEL.(209) 942-0181 • FAX (209) 942-0423 <br /> WHITE Frid Copy YELLOW Pm)m C.In MNK Lrbexamry CSV) <br />