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FGL ENVIRONMENTAL CHAIN-OF-CUSTODY REC`OR�/ LAB PROJECT <br /> .(See Reverse for Instructions) I y 1 9 K;23 NO. <br /> Ift f 2'R k- �! SAMPLERS ti' a I k D. fUC�i.. � ii IV: w i • :_.v _ I i <br /> PROJECT NAME _ _- ti,SAMPLE CONTAINER SAMPLE ate }L I <br /> RIt�TI DESCRIPTION CODES A, Ground water LF �}p'j <br /> PROJECT NUMBER 3 A, 40-ml VOA Vial B. Surface water q. waste t Standard <br /> {�� 7 (SIGN) 1 B;Glass Liter Brass Tube C. Leachate N. BlanWSpAo 2. 5 Day <br /> RECORDER ^' C. Plastic 500,ml F.Other D. Rinseale I. Other 3. 60 Hour <br /> ---- - ..-- -- - -(SIGN) - - - -- - - - - - - ---- - -- --- ---- - - - --- - - - -- <br /> D. Plastic Liter Soillsedimenl 4. Other_ <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS v I <br /> .AND �• � y - - - <br /> S- no PRESERVATION <br /> =s o8 p aY SAMPLE i <br /> QN E-� --M NOTES ASSIGNED CONDITION j <br /> s! I:— a x L� tr` E BOTTLE UPON <br /> L1Af =TIME _..- . , - .- :SAMPLE 1b �. . . .„, _ W.�.... __... _ _ NUMBERS_.. _--RECEIPT_- - _ NOTES <br /> X2Z Sal HE Sit'St <br /> I <br /> 31 <br /> 27- ;L RA. uic + <br /> l <br /> �t E <br /> ✓ IV b, - <br /> r i <br /> i <br /> I.—I 1 1+ . .. .. <br /> I <br /> i <br /> NOTES l MISCELLANEOUS Relinq ished by: (Signature) Received By: (Signature) Date Time <br /> S � rVt(.� 5 : zrrt <br /> Relinquished By: (Signature) Received By: (Signature) Date Time i <br /> S� s as&I � <br /> rt 6c-k4 ,j 1')1 ( 0 T Relinquished By: (Signature) Received By: (Signature) Date Time <br /> tett <br /> Method of Shipment Description of Other Chains-Of-Cust y Qisgathe d By: Si nature) Date Time R*ivedab B : (Signature) Date Time <br /> Transport Container Transported with this l h!i) � i k-.. 2 u <br /> t t!4 =�ti Chain (by Serial No.) (Lt jf 3131�� <br /> L s �} <br /> Send Lab Results to (Name): (Check Office Below) Verbals Requested: Yes ❑ No <br /> ❑ SANTA PAULASTOCKTON ❑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 /> I <br /> FGL ENVIRONMENTAL LABORATORY • 2500 STAGECOACH ROAD • STOCKTON, CA 95215 • TEL.(209) 942-0181 • FAX (209) 942-0423 <br /> WHITE:Field Copy YELLOW:Project Copy PINK:Laboratory Copy <br /> r i <br />