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FGL ENVIRONMENTAL CHAIN-OF-CUSTODY RECORD LAB PROJECT <br /> (See Reverse for Instracliotts) NO. <br /> 74PROJECT NAME L _)NL-V-N—e SAMPLERS '� �1�t tN'��f�! SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> iPnIN3�f yL/1 DESCRIPTION CODES QGroundwetcr -F.'OiI <br /> PROJECT NUMBER .��•�3=y' � �[•! {fri[ �44-mf VOA Vlai B. s�rlace water G. waste (DSlandard <br /> (SIGN) B. Glass Liter E. Brass Tube C. Leachate CW BtanWSpike 2. 5 Day <br /> RECORDER C. Plastic 540-ml. F,Other 0. Rinseate 1, Other 2;fi0 I{put <br /> (SIGN) D. Plastic Liter E. SouSediment 4. Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> _ <br /> CONTAINSn <br /> S <br /> ' <br /> �- r-^8 <br /> PRESERVATION 2 �w �' <br /> $ a°� �� E wu=8 zi <br /> 'SAMPLE <br /> NOTES ASSIGNED ' CONDITION <br /> ,YAT.E TIME SAMPLE ID N "— `x BOTTLE UPON <br /> NUMBERS RECEIPT °NOTES <br /> CIV 1 lt�ln CJ Z. " 14 <br /> LOP 1im- b'a , 1 X+ <br /> P (iU -U(D FIT <br /> r>E 1 <br /> � yNe� <br /> ao "^f <br /> C) -—— ——— +1 1 1. <br /> � C ^ _ <br /> rn g <br /> CWT <br /> m <br /> C <br /> iR 52m. <br /> 93 D <br /> qui ed by: (Signature) Re eived By: (Signature} Dale Time <br /> Relinqu s ed By: (Signature) —'Received By:.(Signature) Date Tirr <br /> Relinquished By (Signature) Received By: (Signature) Date Time <br /> Method of Shipment Description of Other Chains-Of-Custody ',Dispatched By: (Signature) Rate Time Received for lab By:(Signature) Date Time 1 <br /> L! Transport Cohtainer Transported with this \ ' <br /> �) �� Chain (by Serial No.) <br /> Send Lab Results to (Name): (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 120AD • S-I'OCKTON, CA 95215 •TEL.(209) 942-0181 • FAX (209) 942-0423 <br /> «T WIIITL:field Cepy VELLOW:Project Copy PINK:t.ahnratory Copy _ <br /> r <br />