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t: � www ttiwtw■ tttttww ttwtttt� wwll■ � IIIlfifii� � � � � � � � <br /> FGL ENVIRONMENTAL CHAIN-OF-CUSTODY RECORD LAB PROJECT <br /> ..ff ! (See Reverse for Instructions) NO <br /> PROJECT NAME 'YC t-PMPAI`�I SAMPLERS ��" ( r' SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> DESCRIPTION CODES A Grpund Water F Oil <br /> r LU <br /> PROJECT NUMBER �G� /v A 40-m!VOA Via! B Surface Water G waste t Standard <br /> T L/' <br /> �� �/, ; (SIGN( B Glass filer E Brass Tube C Leachate H Blank/Spike 2 y <br /> ` C Plastic 600-ml F Other O Rtnseate I Other 3 60 Hour <br /> RECORDER V <br /> (SIGN) O Plastic Liter E SaeSediment a Other <br /> ' <br /> y NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> c AND e <br /> S m ng PRESERVATIOk $ $ <br /> j3 mg 8 i gx a SAMPLE <br /> LF Cs F� $ E NOTES ABOTTLED COUPON NDITION <br /> DATE TIME SAMPLE ID �' N "i y z NUMBERS RECEIPT NOTES <br /> Co0014 456 11J•�u irnn�b Y <br /> ( I3!,0 C0 - 7- f el r . <br /> f Atm S Cl - O 1 I I <br /> r IF,I I <br /> f`321 `�-N r , r l '�� r� I,7W 1 y c <br /> 01113-Tell IV, Ile <br /> c <br /> NOTES/MISCELLANEOUS JGL�,t1� _ � �r �`nyy,f�s f C� eli qu d by ure) Received By (Signature) Date I Time <br /> l 4 b0 / Ord C-r-�.�dv, C� `7 g 3�<5 <br /> ��f��� S r6'-71 Z 4 e!i q is By (Signature) Received By (Signature) Date Time <br /> i <br /> Relinquished By Nature) Received 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) !1? Gil f f' �0 pyirrr ,; � ✓ �cl r (Check Office Below} Verbalsl Requested Yes ❑ No ❑ <br /> ❑ SANTA PAULA ❑ STOCKTON ❑VISALIA <br /> TEL (805) 659-0910 TEL (209) 942-0181 TEL (209) 734-9473 <br /> FAX (805) 5254172 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 Fuld Copy YELLOW Prnftxt Cop, PINK Laboratory CoM <br />