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FGL ENVIRONMENTAL CHAIN-OF-CUSTODY RECORD ra PROJECT <br /> C / (See Reverse for Instructions) NO. <br /> PROJECT NAME . s SC-L r. 464Z SAMPLERS h 4 SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> DESCRIPTION CODES A Ground water F. Oil <br /> PROJECT NUMBER • Sa u'� �� A. 40-m1 VOA Vial e. Surface water G. waste 11. Standard <br /> i r IG ) B. Glass Liter E. Brass Tube C, Leachate N. Blank/Spike 2. 5 Day <br /> RECORDER / C. Plastic 500-ml F.Other D. Rinseate I. Other 3. 60 Hour <br /> r D. Plastic Lifer E. SoillSe&ment 4. Other <br /> (SIGN) <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> 8 .f AND <br /> am PRESERVATION v"-- <br /> 3g SAMPLE <br /> a o <�_ NOTES ASSIGNED. CONDITION <br /> IF <br /> E6 LL F ° BOTTLE UPON <br /> DA/E/ TIME SAMP ID j, 0 z NUMBERS RECEIPT NOTES <br /> 3 ✓ <br /> U V ✓ <br /> NOTES I MISCELLANEOUS / " _C7 <br /> _ eli__.._is2��= <br /> - _R _ Y: ( g _-_)- —Time- <br /> NOTES <br /> 3&&15 .. C4 we� ived B�Si ngtu �eW Ti <br /> ONe bre e Tl9�f � -Dole 6U. I <br /> Relinquished By: (Signature): ., , . eceived By:(Signature) .,, Date Time w <br /> Vita _f,Mk ,4 egT elf/+ � Relinquished By: (Signature) Received By: (Signature) Date Time <br /> Method of Shipment Description of 1 Other Chains-Of-Custody Dispatched By: (Signature) Date Time Received for tab By: (Signature) Date Time <br /> Transport Cont finer Transported with this <br /> II lee C Chain (by Serial No.) <br /> Send Lab Results to (Name): ' (Check Office Below) Verbals Requested: Yes ❑ No ❑ <br /> ❑ SANTA PAULA �� t�h 6 STOCKTON ❑VISALIA <br /> TEL (805) 659-0910 TEL (209) 942-0181 TEL (209) 734-9473 <br /> FAX (805) 525-4I72 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:Field Cnpy YELLOW:Project Copy PINK: Lahnrainry Copy <br />