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I �vHaqiI6 <br /> FGL ENVIRONMENTAL CHAIN-OF-CUSTODY RECORD LAB PROJECT <br /> a (Y1Gr�(S-ee Reverse for Instructions) NO. <br /> PROJECT NAME _. _-_�__ SAMPLERS— SAMPLE CONTAINERPLE DESCRIPTION CODES AT CODES <br /> DESCRIPTION CODES q. round Water F. oil <br /> PROJECT NUMBER_ _ A 40-ml VOA Vial e. Surface Water G. Waste d <br /> (SIGN) B. Glass Liter E Brass Tube C. Leachate H. Blank/Spike ay <br /> RECORDER ------ C. Plastic 500-m1 F.Other _._. D. Rinseate I. Other _ 3. 60 Hour <br /> (SIGN) D Plastic Liter E. Soil/Sediment 4. Other <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS <br /> o AND <br /> ___ av PRESERVATION dg " "_a <br /> y =o <br /> C I Q; x 8 o'iS SAMPLE <br /> -a� NOTES ASSIGNED CONDITION <br /> E° E= a = v LL � 4�. 2' E o- BOTTLE UPON <br /> DATE TIME SAMPLE ID e�� `V h N Z NUMBERS RECEIPT NOTES <br /> q 1:30 1 W A 415,11361'fl0-L- <br /> 2 1:34. 40 Vo A� <br /> A <br /> 2 K h DL <br /> SO <br /> V1� <br /> NOTES/MISCELLANEOUS //y,)/,R�eli quished b ature) Received By: (Signature) Date Time <br /> C", �y pCt Ms CO �.s� ck�c.v�er' Relin uishe (Signature) Received B (Signature) Date <br /> T I `` q y: ( 9 ) y ( 9 ) <br /> Un'�h4_ �\ 6re[.SfL �lus <br /> Relinquished By: (Signature) Receiv : (Signature) Date Time <br /> Meth d of Shipment Description of Other Chains-Of-Custody Dispatched By: (Signature) e Time Received for lab By: (Signature) Date Time <br /> Transport Container Transported with this <br /> Chain (by Serial No.) Q�f <br /> Send Lab Results to (Name): �/ ON 5 heck Office Below) Verb s quested: Yes El No ❑ <br /> ❑ SANTA PAULA q-,��5,D33� ❑ STOCKTON f ❑VISALIA <br /> TEL (805) 659-0910 TEL (209) 942-0181 - TEL (209) 734-9473 <br /> FAX (805) 525-4172 FAX (209) 942-0423 Oct 1 *3 1no2 FAX (209) 738-6273 <br /> FGL ENVIRONMENTAL LABORATORY • 2500 STAGECOACH ROAD • STOCKTON, CA 9521 � F', )! q �4�{�._4pf1 .( Q9) 942-0423 <br /> ` 'A95211 <br /> field Cop) YELLOA.Project Cupp PINK,Laboratory Cup} �r�f�111I Teti-�Vl�t <br />