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FGL ENVIRONMENTAL CHAIN-OF-CUSTODY RECORD .B PROJECT <br /> Q (See Reverse for Instructions) NO. <br /> PROJECT NAME f � V SSELL SAMPLERS SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> f 1 DESCRIPTION CODES A. Ground water F. Oil <br /> PROJECT NUMBER A. 40-ml VOA Vial B. Surface Water G. Waste 1. Standard <br /> (SIGN( B. Glass Liter E. Brass Tube C. Leachate H. BlanklSpike 2. 5 Day <br /> C. Plastic Soo-ml F.Other D. Rinseale I. Other 3. 60 Hour <br /> RECORDER <br /> (SIGN) D. Plastic liter E. ScQSediment 4. other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS: �t v <br /> `4 AND <br /> PRESERVATION $ " <br /> KB m LL� g8a 8 m SAMPLE <br /> ASSIGNED CONDITION <br /> S. e = u r E °° BOTTLE UPON <br /> E S E 3 <br /> DAYE TIME SAMPLE ID N NUMBERS RECEIPT NOTES <br /> t <br /> ga <br /> NOTES!MISCELLANEOUS <br /> heli wished by: (Signature}" "" a ei"ved y: (Wna. }� t� —u Ti�C "'7 lis,-� <br /> Relinquished By: (Signature) Received By: (Slggature)... Date Time <br /> Relinquished By: (Signature) Received By: (Signature) Dale Time <br /> Method of Shipment Description of Other Chains-Of-Custody Dispatched By: (Signature) Date Time Received for lab By: (Signature) Date Time <br /> NI' Transport Container Transported with this <br /> 4M )9e Chain (by Serial No.) <br /> Send Lab Results to (Name): (Check Office Below) Verbals Requested: Yes RINo ❑ <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:Ficld Copy YELLOW: I'mi[G GAP} PINK:Laboratory Cnpy <br />