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JFJJ <br /> ! f <br /> FGL ENVIRONMENTAL CHAIN-OF-CUSTODY RECORD LAB PROJECT <br /> � F Reverse for Instructions) NO <br /> PROJECT NAME j 1'' 1A SAMPLERS !! � � ' SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> rn` }PRlier�' DESCRIPTION CODES A Ground Water F Oil <br /> t <br /> PROJECT NUMBER -1 14l_ L t—+^ A 40 ml VOA Vial 8 Surface Water G Waste 1 Standard <br /> E I r r ! (SIGN) B Gtass Liter E Brass Tube C Leachate H BlanktSpike 2 5 Day , <br /> t + C Plastic 500 ml F Other D Rmseate I Other 3 60 Hour <br /> RECORDER -(SIGN) D Plastic Liter E Soil/Sediment 4 Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS Y <br /> `o <br /> AND c <br /> o <br /> � - <br /> Rm _ PRESERVATION <br /> og eg LLm lr t v8 a E¢ of=m SAMPLE <br /> vm °m o ro� ti ¢m € 0.2— NOTES ASSIGNED CONDITION <br /> ES Em a x ° BOTTLE UPON <br /> DATF TIME SAMPLE ID, f Z NUMBERS RECEIPT NOTES <br /> f I'-r!i , ,rs'4-, ' 4v ,'F �. f if <br /> r left: ./ �t <br /> aP.ff d•� � 1 „s f f/r Y r" !_ L. i/ <br /> F <br /> CPA,1V <br /> vj1 <br /> M a <br /> f !rr <br /> s <br /> NOTES ISCE LA EOUS y .-Relinqu hedyby {Signature) Recelv6d By (Signature) Date Time <br /> } � f-717 Relinquished By (Signature) Received-Sy(Signature) � date Time <br /> Relinquished By (Signature) Received By (Signature) Date Time <br /> y ! f fa7ccl" J ✓ !'+C�'" %��J[C <br /> ethod of Shipm nt Description of ther Chains-Of-Custody Dispatched By (Signature) Date Time Received for lab By (Signature) Date Time <br /> �> a1 Transport ntainer Transported with this <br /> �I// / Chain (by Serial No) <br /> ( ! / <br /> E <br /> Send Lab Results to (Name) �' r t j �r- r• (Check Office Below) Verbals Requested Yes ❑ No ❑ <br /> ❑ 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 /> FGL ENVIRONMENTAL LABORATORY • 2500 STAGECOACH ROAD • STOCKTON, CA 95215 • TEL (209) 942-0181 • FAX (209) 942-0423 <br /> WHITE FiLld Cap) YELLO" Prujeci Cupp PINK Laboratory Cvpti <br />