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,) <br /> . 0 <br /> FGL EN'VIRONMENTAL"PIHAIN-OF-CUSTODY RECORD LAB PROJECT <br /> Y <br /> (See Reverse for Instructions) Ni). <br /> PROJECTIME 51LXXM4 TAYVA '1bW)N SAMPLERS 4460 VAN L-G SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> (PRINT) DESCRIPTION CODES A. Ground Water F. Oil <br /> PROJECT NUMBER A. 40-m1 VOA vial B. Surface water G Waste 1. Standard <br /> (SIGN) S. Glave Liter E. Brass Tufa C. Leachale H. SlanidSpike 2. 5 Day <br /> RECORDER C. Pfaetic 50o-ml F.Other D. Rinseate I. Other 3. 50 Hour <br /> {54fiN) D.'Plastic Liter E. WIlSadimenl 4, Other <br /> NUMBER OF ANALYSIS REG ESQ LABORATORY USE ONLY <br /> CONTAINERS { u <br /> AND +_ <br /> PRESERVATION $ 'a� <br /> SAMPLE <br /> a- e�$ -<c� NOTES ASSIGNED CONDITION <br /> E _ � <€ °v BOTTLE UPON <br /> r <br /> DATE TIME SAMPLE ID ! = NUMBERS RECEIPT NOTES <br /> 2 .s.l 1 (- IS <br /> _ N 2.3 -*A rVAII L P V4- <br /> It 2-S 11 n c r C 19�4- <br /> If zb 12:+5 <br /> 11 :10 1 r , <br /> It12 15 I " f r <br /> •r. <br /> t <br /> Ir NOTES I MISCELLANEOUS Relinqu' dby: (Signature) Received y: e) Date Time <br /> IUD Relinquished 8y: Ignature) Received By: (Signa '"} 'Date � Time <br /> v�� <br /> t ,� qua � � { Retinquishe y: (Signature) Received By: (Signature) Date Time <br /> Method of Shipment Description of Other Chains-01-Custody Dispatched By; (Signatur Date Time Received for lab By: (Signature) Date Time <br /> Transport Container Transported with this <br /> Chain (by Serial No.) <br /> �UJ";07 <br /> Send Lab Results to (Name): (Check Office Below) Verbal quested: Yes ❑ No ❑ <br /> ��❑• SANTA PAULA ❑ STOCKTON ❑VISALIA <br /> ? TEL (805) 659-0910 TEL (209) 942-0181 TEL (209) 7349473 <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 /> ' WHIT£:Field C,Vy YELLOW:Pni j*i Cup) PINK:I-Aborarary Cup) <br />