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ENVIRONMENTAL CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> Lab Number: TEST DESCRIPTION AND ANALYSES REQUESTED <br /> ,P4Tw <br /> ,client: Live Oak GeoEnvironmental LL I-,.-...,.----"--' i <br /> sig. _ ... <br /> Sti .. <br /> -Customer Number. 3016608 <br /> Address: 407 W. Oak St. s I <br /> Lodi,CA 96240 s f <br /> i <br /> Phone: (209)369-0375 Fax: <br /> r Email Address: abbyQlogelodi.com 8 <br /> Contact Person: Abby Racco ~ L l I <br /> Project Name: Block 21 Winery,21600 N. Davis Rd. <br /> Purchase Order Number: Lodi,CA e _ <br /> Quote NUn117CC 0— <br /> Sampler(s):Sampler(s): 21 <br /> U � � <br /> 0. <br /> N m <br /> « v C <br /> Sampling Fee: _ Pickup Fee: _ I <br /> ZCompositor Setup Date: Time: $ <br /> J Xr <br /> 9 <br /> n <br /> i <br /> Location DescriptionPSanp Sam Sampled z a w A.- I <br /> Date Timc <br /> al <br /> 0 Travel BlankG 730 2 G <br /> __--- . _.._. X <br /> 1 Irrigation Well for Winery /C/f/I'y 7 3C,0 G 3 P/G P DW SRC O X <br /> _. <br /> RUSH-- <br /> Remarks Relinquished Date: Time: Relinquished t • Time: Relinquished Date: Time: <br /> 7 Day RUSH <br /> Re--,' y: Date: Time: Received By: Dx Time: rived By: Date: Time: <br /> 0)4 '°�/8 /a 46 /°%7`e 1.74 d 10(5 11S 5 <br /> Corporate Offices&Laboratory Office&Laboratory Office&Laboratory Reld Office <br /> 853 Corporation Street 2500 Stagecoach Road 563 E.Undo Avenue Visalia,Calitomia <br /> Santa Paula,CA 93060 Stockton,CA 95215 Chico,CA 95926 TEL:559/734-9473 <br /> TEL:805/392-2000 TEL:209/942-0182 TEL:5301343-5818 <br /> Mobile:5591737-2399 <br /> FAX:805/525-4172 FAX:209/942.0423 <br /> CA NELAP Certification No.0111OCA CA ELAP Certification No.1563 FAX:530/343-3807 FAX:559!734-8435 <br /> CA ELAP Certification No.2670 <br />