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C , <br />NUMBER OF <br />CONTAINERS <br />{ AND <br />DATE I TIME I r SAMPLE ID <br />I <br />/ MISCELLANEOUS Gvr� <br />Par e ct `2 L--.'9.�: 1 <br />e �t'rt� tPsT �" (old%(ocn bas' <br />tom\ � c.t.�143 <br />NLAB PROJECTO.- <br />TAT CODES <br />t: Standar <br />ay <br />3. 60 Hour <br />4. Other <br />LABORATORY <br />• . <br />3 Cwt � <br />--�, <br />FGL ENVIRONMENTAL CHAIN -OF -CUSTODY CO <br />= <br />t <br />(See Reverse for Instructions) <br />"$ <br />V <br />PROJECT NAME <br />WlA0Md1K2 SAMPLERS E21r- OOL2 1204 <br />SAMPLE CONTAINER <br />SAMPLE DESCRIPTION CODES <br />( (PRIM <br />DESCRIPTION CODES <br />A. Ground Water F. Oil <br />r <br />PROJECT NUMBER <br />� <br />,.2 J..—IZ_ <br />40 -ml VOA vial <br />B. Surface Water G. Waste <br />(SIGN) <br />Glass Liter E. Brass Tube <br />lljLeach H. Blank/Spike <br />RECORDERLZII <br />C. Plastic 600 -ml F. Other <br />D. Rinseate 1. Other <br />(SIGN) <br />D. Plastic Liter <br />E. Soil/Sediment <br />C , <br />NUMBER OF <br />CONTAINERS <br />{ AND <br />DATE I TIME I r SAMPLE ID <br />I <br />/ MISCELLANEOUS Gvr� <br />Par e ct `2 L--.'9.�: 1 <br />e �t'rt� tPsT �" (old%(ocn bas' <br />tom\ � c.t.�143 <br />NLAB PROJECTO.- <br />TAT CODES <br />t: Standar <br />ay <br />3. 60 Hour <br />4. Other <br />LABORATORY <br />Relin wished by: (Signature) <br />RecE <br />=D. <br />l <br />y <br />= <br />RecE <br />SAMPLE <br />"$ <br />V <br />Relinquished By: (SignatuLg)�- <br />NOTES <br />ASSIGNED CONDITION. <br />gV <br />NUMBERS RECEIPT <br />Relin wished by: (Signature) <br />RecE <br />=D. <br />Relinquished By: (Signature) <br />RecE <br />Relinquished By: (SignatuLg)�- <br />Rec( <br />nature) <br />NOTES <br />Transport Container Transported with this <br />�p t� Chain (by Serial No.) <br />Send Lab Results to (Name): (Check Office Below) Verbals uested: Yes ❑ No Er— <br />SANTA PAULA RSTOCKTON ❑ 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 />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 />a <br />