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• � <br /> FGL ENVIRONMENTAL CAN-OF-CUSTODY RECORD <br /> NO sk PROJECT <br /> (See Reverse for Instructions) <br /> PROJECT NAME �I <br /> SAMPLERS Cr-1t-[7`J� SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> (PRINT) DESCRIPTION CODES A Ground wrier F 011 <br /> A 40 ml VOA Vial <br /> B Surlace water G waste 1 Standard <br /> PROJECT NUMBER (SIGN) B Glass Liter E Brass Tube C Leachate H elank/Spike 2 5 Day <br /> C Plastic 500 ml F Other 0 Rinseate I Other 3 60 Hour <br /> RECORDER D Plastic LiterE SoillSedimeni 4 Other <br /> (SIGN) <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS (3 <br /> a y m <br /> i AND — <br /> i' v <br /> m ll m$ x' $& s <br /> PRESERVATION <br /> m� SAMPLE <br /> a <br /> E - aU NOTES ASSIGNED CONDITION <br /> °J BOTTLE UPON <br /> E E, LL NUMBERS RECEIPT NOTES <br /> DATE TIME SAMPLE ID <br /> I � Rellnqul5 y ignature) Re Ived�y (Signature) <br /> to Time <br /> NOTES MISCELLANEOUS <br /> Relinquished By (Signature) eceived By (Signature) Date Time <br /> Relinquished By (Signature) Received By (Signature) Date Time <br /> Method of Shipment Description of Other Chains Of Custody Dispatched By (Signature) <br /> Date Time Received for lab By (Signature) Date Ttme <br /> Transport Container Transported with this <br /> Chain (by Serial No) <br /> Send Lab Results to (Name) (Check Office Below) Verbals Requested Yes El No El <br /> EJ 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 /> FG1, ENVIRONMENTAL LABORATORY • 2500 STAGECOACH ROAD • STOCKTON, CA 95215 • TEL (209) 942-0181 • FAX (209) 942-0423 <br /> WHITE Fold Copy 5 Ek LOW Prnjeci Cup. PINK Laboratory Cop} <br />