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RONMENTAL C�-OF-CUSTODY RECORD <br /> S PROJECT <br /> FGL ENVI No. <br /> f� �j" (See Reverse for Instructions) I <br /> PROJECT NAME _/�� r — SAMPLERStPR <br /> � SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> DESCRIPTION CODES A Ground Water F Oil <br /> A 4t}ml VOA V al - e surface Water - G Waste t Standard <br /> PROJECT NUMBER B Glass Liter E Brass Tutee C Leachate H BlankfSpike 2 5 Dao} 4 Other Hour <br /> C Plasftc 500-m1 F Other t) Rinseate ` + ��r 4 Other <br /> RECORDER Y D Plastic Liter E Soll($ediment <br /> f {SIGN) <br /> NUMBER OF ANALYSIS REQUESTED LABORATORY USE ONLY <br /> // J �r 3 CONTAINERS F <br /> i�z- <br /> 0 <br /> /Om/J14 AND _PRtoN B �- <br /> SE¢ SAMPLE <br /> NOTES ASSIGNEE) CONDITION 80TTLE UPONNOTES <br /> - NUMBERS RECEIPTDATE TIME SAMPLE ID `�W -l49 � ,` /lfv� r <br /> x <br /> Time <br /> t e+nq Is ed by SuDate ture) Received By ( Ignature) r <br /> N�TESIMISCEWANEOUS/--�,///A7,,� -/041e <br /> j211 S-,7. 1-UP, 7S 2-0600I7y °'f '�! - e qu teed By (SI nature) elved By (Signature) - Date Time <br /> 4- loh rrru</-r UJ,-� ,� �/�»'iv �",Q�s� z z 2 <br /> / - Relinquished B (Signature) Received By (Signature) Date Time <br /> I-V�,,,q�� �5� �r <br /> 1 1 Date Time Received for lab By (Signature) Date Time <br /> Method of Shipment Description of Other Chains-Of-Custody Dispatched By (Signature) <br /> Transport Container Transported with this <br /> Chain (by Senal No) <br /> Send Lab Results to (Name) (Check Office Below) Verbals Requested Yes ❑ No ❑ <br /> ❑ STOCKTON ❑VISALIA <br /> ❑ SANTA PAULA TEL (209) 942-0181 TEL (209) 734-9473 <br /> TEL•(805) 659-0910 FAX (209) 738-6273 <br /> FAX (805) 525-4172 FAX (209) 942-0423 <br /> FGL ENVIRONMENTAL LABORATORY • 2500 STAGECOACH ROAD • SCOCKTON, CA 95215 • TEL.(209) 942-0181 • FAX (209) 942-0423 <br /> WHITE Field Copy YELLOW Proles Cop+ PINK Laboratory Cap) <br />