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_ FGL ENVIRONMENTAL CHAIN—OF—CUSTODY RECORD LAB PROJECT <br /> (See Reverse for Instructions) NO'. } <br /> PROJECT NAME �?C SAMPLERS UJ• lr SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TEAT CODES <br /> INT) DESCRIPTION CODES A Ground Water F Oil r {QU) <br /> A 40-mi VOA Vial 8 Surface water G waste t Standd <br /> PROJECT NUMBER L500J r !'t <br /> /� <br /> (SIGN) B Glass Luer E Brass Tube C Leachate H BlanklSpike 2 5 Day uT <br /> / C Plastic$DD-ml F Other D Rinseate I Other 60 Hour <br /> RECORDER (SIGN) D Plastic Liter E SodlSediment 4 Omer <br /> J <br /> v NUMBER OF WYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS U <br /> AND <br /> PRESERVATION E Z- ° 3 <br /> E si= SAMPLE <br /> lq�zo t� �� E~ m° NOTES ASSIGNED CONDITION <br /> ES = L w �` s E °' BOTTLE UPON <br /> DATE TIME SAMPLE ID N _ ol = NUMBERS RECEIPT NOTES <br /> '.a 4 S - MO. / ►nC1CA <br /> 1/15- -30 Me C2,14 <br /> 117? <br /> 1r I-, 15--� 9 f { v <br /> ,1 r rs3� <br /> NO 115 or <br /> t <br /> too it <br /> NOTES/MISCELLANEOUS !i/I tI o (A A.)Tf F il) C'Cj� /SU0 57awII quls ep by (Si re) Received By (Signature) Date tme # <br /> �r A c)c e-}inn,Ov T-C-il ATW, PACC �/ C Y <br /> � T tai 1`�bh Clc� N� � t0 I, sed By (Signa tire) Received By (Sign Date Tlme <br /> S A L Oi5S;U �— 5 <br /> V r� fi�I10r�wCj! � • � q 4(off 4,5&1 Or 3`6- Lry� elingwshe�,r(Sr nature) Rerpelved By (Signature) Date Time <br /> Method of Shipment Description of Other Chains-Of Custody Dispatched By (Slgnat er Date Time Received for lab By (Signature) Date Time <br /> Transport Container Transported with this <br /> Chain (by Serial No) N <br /> _? ' % Send Lab Results to (Name) u r ra 9 6z r (Check Office Below) V Verb" Requested Yes ❑ No ❑ <br /> ❑ SANTA PAULA oeeo( G STOCKTON ❑VISALIA <br /> TEL (805) 659-0910 � 1 C1to 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 /> WHITE Fuld Copy YELLOW Pm}ecl Copti PINK Laboratory Cup) <br /> �9 !• I= t_ Itl� �■Ilr IIIA s 1� <br />