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FGL ENVIRONMENTAL CHAIN-O&CUSTODY RECORD LAS PROJECT <br /> (See Reverse for instructions) NO. 1/471 <br /> PROJECT NAME �11'- �'k�' A,CSAMPLERS ILr a4� SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> 1 4 . {� DESCRIPTION CODES A. Gmuna wow F. d <br /> A. 41-W VCA WO S. sudohm Waage G W"W �Suppod <br /> Z i B. cuw Uw 6 aua Carr 3. <br /> C. Learma H. awmap" S Uw <br /> C. Prc M-W Caw nieruM r.Caa. W ear <br /> RECRECORDER. �� ~, ..a- D. Phoc uur �. $adas�d�nren _ —___ 4. Care <br /> LU FLU NUMBER OF A YSIS OU ED LABORATORY USE ONLY <br /> e J 7 CCNT�Ra Y <br /> Q 4— Pea SERW'�ON � � f p Ij.— LLI — � SAMPLE <br /> T' Z �' �r NOTES ASSIGNED CONDITION <br /> i_- v ` BOTTLE UPON <br /> RECEIPT NOTES <br /> T TIME LIG-R? <br /> r j NUMBERS <br /> !q sVfr� _ 0- <br /> me A& Zz _ 1 <br /> IV t4 0I <br /> �NOTES�ILLANEOUS by: (S' ature) eiwed : (Si s) D e Time <br /> MUTT1 LL Ina1 -' "t]a ul g� 16 <br /> i� , y:fsgRa�ua IR ed By:{ ' Wray ie Tu <br /> ' J o. <br /> F Relinquished By: (S10INt u ) wed df:( urs) Date Time <br /> G1n1 G8 d =L L_ <br /> Method of Sllhi__pment Description of Other Chains-01-Custody Dispatched By: (Signature) Date rime Received for lob By:(Signature) Date Tirrw <br /> SL�. f✓Y►�St Transport Contairrsr Chai 8arW Ngo <br />.. "�"YvC <br /> • <br /> Send Lab Results to (Nanta): CC 1K Ftthrr. `6�• is T. w.r%+,ra. It h c (Check Office Below) Verbals Requested: Yes ❑ No <br /> ❑ SANTA PAULA C h-WKTON ❑V15ALIA <br /> TEL(80S) 659-0910 / TEL (209) 942-0181 TEL (2091734-9473 <br /> FAX (WS) 525-4172 FAX (204) 942.0423 FAX (204)738-6273 <br /> FGL ENVIRONMENTAL LAW)RATORY • 2508 STAGWOACII ROAD * SI'OCKTON, CA 95215 ,, TEL.(209) 942-0181 • FAX (2891 942.)423 <br /> viral'!::FW Cor YEW":hqa-1 C." MHK7 Ubmamy Con <br />