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FGL ENVIRONMENTAL CH*-OF-CUSTODY RECORD *PROJECT <br /> (See Reverse for Instructions) NO <br /> PROJECT NAME (4,Akrjjf�- k) L(f9 t' SAMPLERS Aj lr�r _ SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> ! tPMINT) ,y/ DESCRIPTION CODES A Ground water F oil <br /> PROJECT NUMBER W r 2� r I 1 t' f A 44m1 VOA Vial a Surface Water G Waste I Standfd <br /> f I O (SIGN) B Glass Liter E Brass Tube C Leachate H BlanklSprke 2 5 Day' <br /> RECORDER�� /`� ✓ C Plastic 500 ml F Other D Rinseate I Other f3 so No <br /> (SIGN) D Plaslic Liter E So+llSediment JOlher <br /> J <br /> NUMBER OF CANALYSIS REOUESTED LABORATORY USE ONLY <br /> CONTAINERS e <br /> t1 <br /> AND <br /> w m gd PRESERVATION 976 <br /> t mB <br /> L€¢ No= SAMPLE <br /> 2V o- NOTES ASSIGNED CONDITION <br /> Ed E= a 1- £ BOTTLE UPON <br /> DATE TIME SAMPLE ID _ N NUMBERS RECEIPT NOTES <br /> to <br /> { <br /> t <br /> NOTES/MISCELLANEOUS + ('�rn - � �"J A)JE '1 COP'-' �Y0 r� 5 rp r/ � {� Iinquls ed by (Sign Received By (Signature) Date I ,--Time <br /> � G�` � 't v4ix% (Ari;Z,1` � c�7�� 1 /d/�4�'C ��i��E �f/, i. r � 1 ,, /l; �,f'I` r �� --� <br /> Qri yisAed By (Signature) Received By (Signature)-- Date Time <br /> Relinquished By (Signature) Received By (Signature) 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 /> r , 1 r <br /> Send Lab Results to (Name) (t r v r Mo 4r— 0-A A j)r r:-v r rr r/, 25_22C (Check Office Below) Verbals Requested Yes ❑ No ❑ <br /> El SANTA PAULA y (( t 1+t� i ❑ STOCKTON ❑VISALIA <br /> TEL (805) 659-0910 _r,� ! ' + ' TEL (209) 942-0181 TEL (209) 734-9473 <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 /> H HITE Field Grp, 1 ELLO`h Prutau Cup, PINK Labnrdtary C,,p% <br />