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FGL ENVIRONMENTAL CHAIN-OF-CUSTODY RECORD LAB PROJECT <br /> I (See Reverse for Instructions) NO. <br /> t PROJECT NAME YdfilSAMPLERS <br /> DESCRIPTION <br /> CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> j C IPRII� CODES A- Ground water F oil <br /> PROJECT NUMBER W / A. 40-ml VOA Vial B. Surface Water G- Waste 1 Standard <br /> {SIGNI B. Glass Liter E. Brass Tube C. Leachate H 80anklSpike 2 5 Day <br /> RECORDE C Plastic 500-ml F Other_ ,-_ D Rinseate I Other 3 60 Hour <br /> (SIGN) D. Plastic Liter _ -. ... E. Soil/Sediment _ - a Omer <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> .. `o AND E v <br /> _ y <br /> pm am PRESERVATION $ <br /> =b$ <br /> a8 <br /> �6 E =r SAMPLE <br /> i E- g� m = d`—' m�o`—' NOTES ASSIGNED CONDITION <br /> BOTTLE UPON <br /> DATE TIME SAMPLE ID 13 12 § m o NUMBERS RECEIPT z NATES <br /> ,.i <br /> �f, •1 <br /> +rj - <br /> I <br /> i <br /> I <br /> i� <br /> l <br /> NOTES 1 MISCELLANEOUS Inquis d b4(Signature) <br /> Received By: (Signature) Date Time <br /> �i PQ• � Relinquished BReceived By: (Signature) Date Time <br /> Relinquished By: (Signature) ReceivedBy; (Signature) Date Time <br /> Lit <br /> Method of Shipment Description of Other Chains-Of-Custody Dispatched By: (Signature) Date Time Receivedfor lab By: (Signature) Date Time <br /> Transport Container Transported with this <br /> Chain (by Serial No.) + <br /> j Send Lab Results to (Name): yid NIA 0 —/G8 (Check Office Below) Verbald Requested: Yes ❑ No ❑ <br /> ❑ SANTA PAULA 2-2104"91 VISIA 15;V& ❑ STOCKTON ❑VISALIA <br /> TEL (805) 659-0910 . TEL (209) 942-0181 TEL (209) 734-9473 <br /> i 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 /> 0. rCill"t Fcetd Copy YLI-Low_Project 0,p� PINK_Labowory Cupl <br /> r <br /> 41 <br />