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FGL ENVIRONMENTAL CHAIN-OF-CUSTODY RECORD LAB PROJECT <br /> �r3 L (See Reverse for Instructions) NO <br /> Il <br /> PROJECT NAME fft /V e*—' e [-1 / �f��/t SAMPLERS r SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> '�— (PRI DESCRIPTION CODES A. Ground Water F- Ou <br /> PROJECT NUMBER �� 1�� ,2- Li / A. 4o-ml VOA vial B. Surface water G- Waste . 1. Standard + 1 r <br /> B. Glass Liter E. rass Tube C, Leachate H. BfankJSpike + 1 / d <br /> RECORDER l ` '"� ���-'-'�� C, Plastic 5oi Other_ ., Rinseate I. Other 3. 6---Ho i <br /> (SIGN) D. Plastic Liter _ ScillSediment q <br /> - er <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> AND <br /> RVATION <br /> m nu <br /> �-- oFSE <br /> 3 =i SAMPLE <br /> �" Z ¢a a 1`–' " NOTES ASSIGNED CONDITION <br /> Ev E _ �� `V a o BOTTLE UPON <br /> Tf€ TIME <br /> li 0= <br /> D SAMPLE ID N z° NUMBERS RECEIPT NOTES <br /> ► t t - ?C--- / d• r L' i1 <br /> s _ Q- . <br /> F _ _ <br /> rf ?�'•�� 5I -;�O <br /> I i i!1 U_h ff 9D r <br /> !F , . tic, <br /> G7 5/1+' <br /> NOTES I MISCELLANEOUS �� CL� ��cr Ii shedj(S�i gnature) TiReceived By: (Signature) Date i- me <br /> f �.-�� <br /> d ' `rr Relin uished B <br /> �I177, 5���' �Aal't)q/ S� ' / "� '��ll �' q y: (Signature) Received By: (Signature) Date Time <br /> t <br /> Relinquished By: (Signature) Received B (Signature) <br /> Y� <br /> Date Time <br /> Method of Shipment 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 /> Chain (by Serial No.) <br /> Send Lab Results to (Name): (Check Office Below) Verbals Requested: Yes No ❑ <br /> ❑ SANTA PAULA 1t Alec TOCKTON ❑ SALIA <br /> TEL (209) 942-0181 VI <br /> TEL (805) 659-0910 VI <br /> 7C' <br /> FAX (805) 525-4172 ���= �� ��J FAX (209) 942-0423 ATTACHMENT <br /> FCL ENVIRONMENTAL LABORATORY • 2500 STAGECOACH ROAD • STOCKTON, CA 95215 • TEL.(209) 942-0181 • LABORATORY ANALYSES <br /> H'HIl'b:: PicIJ('upy }'Fif.l-p N'.Pniica("pi PINK;I.ui C,,i & CHAIN-OF-CUSTODY <br />