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FGL ENVIRONMENTAL CHAO-OF-CUSTODY RECORD LOROJECT <br /> (See Reverse for Instructions) NO <br /> PROJECT NAME M(r,A- 61-4cr 5 SAMPLERS } }^ �-- --- SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> (PRINT) DESCRIPTION CODES A Ground water F Oil <br /> PROJECT NUMBER I` �-j^ �� t Ic- l1k,4,t. A 413-mi VOA Vial B surface water G waste t standard <br /> (SIGN) B Giass Liter E Brass Tube C Leachate H BlarildSpike a <br /> C PlasiK R <br /> 5Mml F Other D mseale I Other <br /> RECORDERHaur <br /> 3 D Plastic Liter E SotVSedirrient 4 Other <br /> (SIGN) , <br /> NUMBER OF AN IEII!REOUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> AND <br /> € 8 <br /> E— am PRESERVATION _ , <br /> $ 8 <br /> a: SAMPLE <br /> y ASSIGNED CONDITION� BOTTLE UPONEs E ° <br /> DATE TIMESAMPLEID NUMBERS RECEIPT <br /> NOTES <br /> G'f 1 iW tI t �— 41 " VIX <br /> ,► tz y G V xX V <br /> CD <br /> 4, <br /> X <br /> k i l o- 10 1 4 L <br /> ~ 1Is t ° 1q G X Z M <br /> e Lto noU r <br /> �s <br /> It)qulpS ` Y1( L <br /> eceived By (Signature) Date Time <br /> NOTES <br /> U <br /> Cc, 5 s p L 4 i q Is By (Signa re) Received By (Signature) Date Time <br /> �' (o.,rtr_ ��- f� s� �,,•,, CCI Lr. C c L�, �b, EIS ��� Z^ <br /> ,Relinquished By (Signature) 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 n C1�I <br /> Send Lab Results to (Name) WM y (Check Office Below) Verbals quested Yes ❑ No ❑ <br /> ❑ SANTA PAULAy s� <br /> 9} I -ILg.3 ❑ 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 /> FCL ENVIRONMENTAL LABORATORY • 2500 STAGECOACH ROAD at STOCKTON, CA 95215 a TEL (209) 942-0181 • FAX (209) 942-0423 <br /> A HITE Field CiipN 1 FLLO%k Prow G p, PINK Laboratory Copy <br />