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PROJECT <br /> FGL ENVIRONMENTAL C -OF-CUSTODY RECORD � , <br /> �^� (See Reverse for Instructions) - Nq. * r <br /> PROJECT NAME (ALjffeJ Ce R 7 SAMPLERS U)+ MI t' SAMPLE CONTAINER SAMPLE DESCRIPTION CODES AT c4DES' - <br /> INTI DESCRIPTION CODES A Ground water F Oil <br /> PROJECT NUMBER L503A 4o-ml VOA Viat B Surface Water G waste I Slam <br /> 560 2 {SIGN) B Glass Liter E Brass Tube C Leachate H BlanklSp=ke 2 5 Day <br />' 4 C Plastic W(0 rnl F Other D Rinseate 1 Other e0 Hour <br /> RECORDER (SIGN) D�Plastic Liter E SoilJSedimertt other <br /> NUMBER OF WYSIS REQUESTED LABORATORY USE ONL <br /> CONTAINERS v <br /> AND k <br /> sB — PRESERVATION $ y .. <br /> SAMPLE <br /> Iq�Z �o Z ws aU to E m" NOTES ASSIGNED CONDITION <br /> E- E- = V LL - �� E >Y BOTTLE UPON <br /> DATE TIME SAMPLE ID �' y 2 y z NUMBERS RECEIPT NOTES <br /> ! 104V - lyd. / r0%C14��yy <br /> rr rr 11 tX-1� rr <br /> id <br /> CIA 1 <br /> Al W lA) /12 <br /> 00 <br /> 1115- /5,30 Nd -#or 5 or <br /> Il <br /> NOTESIMISCELLANEOUS ���/ � O AOTEF0 cceP 5-o0 5' orw / I quls by (S re) Received By (Signature) Date ime <br /> Qc3,50C e4"M,CA, 4sZOT AT—t tl- A. CC ASCEI•.u, fill ; <br /> T b� $h CYNod Ir ed By (Signa ure) Received By (Slgnatur Date Time <br /> V rM r6Or��` N(, ` (10T)+(P246151 ore Sd- &I I- etinquished B nature) Re <br /> peiv�d By (Signature) Date Time <br /> Method of Shipment Description of Other Chains-Of-Custody Dispatched By (Sign5We Date Time Received for lab By (Signature) Date Time <br /> Transport Container Transported with this <br /> Chain(by Senat No) <br /> Send Lab Results to (Name) V NAP 9 2r (Check Office Below) Verbfils Requested Yes ❑ No ❑ <br /> ❑ SANTA PAULA (� 5 a ) ❑ STOCKTON ❑VISALIA <br /> TEL (805) 659-0910 1 CZt�} � `� '�- 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 (289) 942-0423 <br /> WHITE Field Copy YELLOW Pn)jmt Cap} PINK Laboratory CIT <br />