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• FGL ENVIRONMENTAL CHIC-OF-CUSTODY RECORD 0 PROJECT <br /> (See Reverse for Instructions) NO. <br /> PROJECT NAME SAMPLERS r 9UrJjLL� SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> (PR�+TI DESCRIPTION CODES A Ground wafer F oil <br /> PROJECT NUMBE l � V�C ��i r� r !-r�,+,s.X�! A 400.m1 VOA Vial 0 Surlace Water G Waste i Standard <br /> B Glass Liter E Brass Tube C Leachate H Blank/Spike 0 5 Day <br /> RECORDER u`1 u �}f C Plastic 500-mi F Other D Rinseate I Other 3 60 Hour <br /> {SIGN} ^� -- _— D Plashi;Leer E SoliSedimem 4 Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS (� u <br /> u - - AND :{ $ <br /> a r�i _ a <br /> PRESERVATION $ f <br /> t a �& $ s <br /> �s s- <br /> E ¢ a rB. SAMPLE <br /> viap Y^I1 f ao o� NOTES ASSIGNED CONDITION <br /> DATE TIME SAMPLE ID ^_NT = 4 2 2 N z BOTTLE UPON <br /> NUMBERS RECEIPT NOTES <br /> Z i <br /> If 4i <br /> � I <br /> - ' 1 <br /> r <br /> f t /i1 t <br /> *�- oar , <br /> NOTES/MISCELLANEOUS ,�� _ �"raNr �v1tC_�77 aC/ trfilehn hed bZ;f(S nature) Received By (Signature) Date Time <br /> /1Lt' 3. l <br /> /ur{ 5 -jv rU✓t ��Pyt l + ( telt ilshed By (Signature) Received By (Sign_ture Date Time <br /> "//r1 u vv% ci ►'M I',, C k ro rmt y m <br /> + <br /> Cobs(+r Co pix r /L1 <br /> , {�+ rrE�4 rY+{YicCC/, Z✓14 =' Relinquished By (Signat6Ire) Recply By (Signature) Date Time <br /> 'r. <br /> Method of Shipment Description of Other Chains-0f-Custody Dispatched By (Signature) Date Time Received for lab By (Signature) Date Time <br /> Transport Container Transported with this <br /> Chain(by Serial No) I/ <br /> r r u% V <br /> Send Lab Results to (Name) Yl & lir 'A24 22 r, 117; 1-,+1 Qr Sxr•rr f ( heck Office Below) Verbais requested Yes El No ❑ <br /> ❑ SANTA PAULA Y r>��) `117 ❑ STOCKTON ❑VISALIA <br /> TEL (805) 659-0910 1�� TEL (209) 942-0181 TEL (209) 734-9473 <br /> FAX (805) 525-4172 FAX (209) 942-0423 FAX (209) 738-6273 <br /> 1 CL ENVIRONMENTAL LABORATORY • 2500 STAGECOACH ROAD • STOCKTON, CA 95215 • TEL (209) 942-0181 a FAX (209) 942-0423 <br /> NHIT£ F.W C," )FLLOW Pnptio C p, PINK Labex wy 01K <br />