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0 FGL ENVIRONMENTAL CAN-OF-CUSTODY RECORD PROJECT <br /> _ (See Reverse for Instructions) NO <br /> PROJECT NAME �I SAMPLERS SAMPLE CONTAINER SA PL�E-DES-CRIPTION CODES TAT CODES <br /> : 'y Pit" t j+N/�/ DESCRIPTION CODES A Ground waler F Oil <br /> A 40 ml VOA ural _ <br /> PROJECT NUMBER !�'��Or`•� B Surface water G waste Q1,)5tandard <br /> (SIGN) B Glass liter E Brass Tube C Leachate H BlankfSpike 2 5 Day <br /> RECORDER C Plastic 6Mrnl F Other �D Rinseate I Other 3 60 Hour <br /> Plastic(SIGN) D Leer E�iolllSadrmen! 4 Other <br /> W JAI.9ALYSIS REQUESTED LABORATORY USE ONLY <br /> T151— LL-Iff <br /> SAMPLEsNOTESASSIGNED CONDITION <br /> DATE TIME SAMPLE ID y BOTTLE UPON <br /> 7{ r ocATrofJ — NUMBERS RECEIPT NOTES <br /> Oad �rTiDiJ — l _ C 1�c'I i <br /> a' f r'{ <br /> ( in 1 d <br /> 1076 1-O,-,11Al�r 1.3 2 6• ( e Ci r <br /> IG3a L,I I. 110 1 w 31 f <br /> /OM li jr a�J '`� f s•,1 <br /> /0.4x4 <br /> 122 <br /> ?4 <br /> 17,T, tF1, JA <br /> 14 <br /> '( 171 j J lr <br /> NOTES I MISCEILANEIOUS v OC,*7v J A -4p' G/ .r / <br /> _ ! 3 t -1 le r phi qui h d by�( g tore) Receyv d B <br /> u f y ( tgnature) to Time <br /> f Gln # , I � 31s+ 3c• ' l t `i �t',11 1 ) -- I ;i. <br /> A �p�� . �r f�1 1 ti rot i- B Ingl +s ed By (S nature) ( Rece+ved By (S+gnature} ate Time <br /> ✓ i <br /> Aelinquished By (Signature) - Received By (Signature) Date Time <br /> Method o� hipment 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 /> 7--c' t ,,�y. Chain (by Serial No) <br /> Send Lab Results to (Name) kPZZZo�.ay rr f/.� , r dc. (Check Office Below) Verbals Requested Yes El ❑ <br /> ❑ SANTA PAULA � G `� /SoZ� El STOCKTON <br /> TEL (805) 659-0910 �� �!G 4 z2 "' ❑VISALIA <br /> 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 Field Copv YELLOW Pn,jcci GT% PINK Laboraim CopN <br />