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IRONMENTAL CHAIN-OF-CUSTODY RECORD C8 PROJECT <br /> /"`rT (See Reverse for Instructions) NO. <br /> PROJECT NAMESAMPLERS i SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> INT DESCRIPTION CODES A. Ground Water F. Oil <br /> PROJECT NUMBER A. 40-ml VOA Vial B Surface water G. waste t. Standard <br /> (SIGN) B. Glass Liler E. Brass Tube C. Leachate H. BlankfSpike 2. 5 Day <br /> RECORDER C. Plastic 500-m1 F Other D Rinseate 1, Other 3. 60 Hour <br /> D. Plastic Liter E. Soil/Sediment 4. Other <br /> (SIGN) <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS- u <br /> cAND� $.. <br /> -A� _gm PRESERVATION 8 mg S S �� <br /> SAMPLE <br /> p08 a LLu E mU a`v NOTES ASSIGNED CONDITION <br /> am _ - a - °- BOTTLE UPON <br /> �- `s <br /> D E TIME SAMPLE ID s y = NUMBERS RECEIPT NOTES <br /> ;. <br /> r IEE <br /> qf%'Re0z_ dAA1 <br /> _ <br /> NOTES!MISCELLANEOUS 5 COp �� SU/T C e is y: I lure) Re eiv igriat ate- - Time-­ <br /> NOTES <br /> tme- - -- <br /> l ' 3 =L <br /> i lr Relinquished By: (Signature) ceived By: (Signature) .. to Time , <br /> ►fpr LL 7a U 5Z''17 D <br /> RES � `' /4- . Relinquished B (Signature) Received B (Signature) Date Time <br /> 4 Y: { g ) y� ( 9 ) <br /> a'7,01 a7-7 t6E w AcMmemm 4- el 9 2-r <br /> Method of Shipment escription of Other Chains-Of Custody Dispatched By: (Signature) Date Time Received for lab By: (Signature) Date Time <br /> Transport Container Transported with this <br /> CP e Chain (by Serial No.) <br /> Send Lab Results to (Name): 494r­#4!!7_ S 5 (Check Office Below) Verbals Requested: Yes ❑ No ❑ <br /> ❑ SANTA PAULA 4I j TE5T5- 770 OF ❑ STOCKTON ❑VISALIA <br /> TEL (805) 659-0910 J!Z)S, TEL (209) 942-0181 TEL (209) 734-9473 <br /> FAX (805) 525-4172 0 T RI-CoVAlTV FAX (209) 942-0423 FAX (209) 738-6273 <br /> C UA R Ew <br /> FGL ENVIRONMENTAL LABORATORY • 2500 STAGECOACH ROAD • STOCKTON, CA 95215 • TEL.(209) 942-0181 • FAX (209) 942-0423 <br /> WHITE:Field Copy YELLOW, Prnject Cnpy PINK: LIINwaiory Capy <br />