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r <br /> i <br /> ' V PROJECT <br /> FGL ENVIRONMENTAL CN-OF-CUSTODY RECORD 41, <br /> 44 (See Reverse for Instructions) NO. <br /> �•k PROJECT N4ME0K t ' �6M45 PO SAMPLERS 0,140 144PV SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> DESCRIPTION CODES A. Ground Water F. oil <br /> PROJECT NUMBER r s L{ A. 40-ml VOA Vial B. Surface water G. Waste 1, Standard <br /> -'� - - - GN) B. Glass Liter E. Brass Tube C. Leachate H. elankfSpike 2. 5 Day <br /> RECORDER 6� C. Plastic 500-mi F.Other A. Rinseate I. Other 3. 80 Hour <br /> ix - - _ - - - (SIGN) - - - O :Plastic Liter E. SoillSediment 4. Other - <br /> tS�lt NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY I <br /> CONTAINERS o <br /> AND R <br /> . -- — PRESERVATION <br /> S LLx X SAMPLE <br /> $ � i o" _ F w `� NOTES. ASSIGNED CONDITIONf. <br /> r_ x 17 BOTTLE UPON <br /> DATES TIME SAMPLE ID � = NUMBERS RECEIPT NOTES <br /> NOTES 1 MISCELLANEOUS / aAli' utsh b4 y- (Signature) <br /> R ived : (S+gnature)., Oa Time <br /> _ <br /> - _ elin11 , <br /> quished By: (Signature) Aecelved By:(Signature) ate 'Time ` <br />�•_ (' / Relinquished By: (Signature) Received By: (Signature) Date Time <br /> Method of Shipment Description of Other Chains-0f-Custody Dispatched By: (Signature) Date Time Received for lab By: (Signature), Date Time <br /> i Transport Container Transported.with this <br /> Chain (by Serial No.) <br /> k Send.Lab Results:to (Name}: u Y' �, -7�1!; [044*,:-e s'' 7' <br /> Check Office Below) Verba{s Requested: Yes ❑ No ❑ (� <br /> ❑ SANTA PAULA' : . ❑,-STOCKTON ` CVISALIA <br /> TEL 09=&10 : - -TEL.(209)_942-0181 TEL (209)734-9473 <br /> FAX(805)'.5254172 FAX (209) 942-0423 <br /> r _ _ FAX (209) 738-6273 <br /> - = , <br /> FGL ENVIRONMENTAL;LABORATORY•2$00 STAGECOACH ROAD • STOCKTON, CA 95215 • TEL. 942-0181 • FAX (204);942-0423 <br /> ? WHITE:Field Copy `'YELLOW:Project Copy PINK:Labors0ory Copy <br /> s r k <br />