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CHAIN OF CUSTODY <br /> •E'NVMwww fgllnc.COm AND ANALYSIS REQUEST DOCUMENT <br /> Client: Diane Allev Lab Number: TEST DESCRIPTION AND ANALYSES REQUESTED <br /> Customer Number: $017752 1_7•_�2 F, j 2- <br /> Address: <br /> Address: 5151 E. Morada Ln <br /> Stockton, CA 95212 <br /> phone: (2(]9)403-3341 Fax: <br /> Email Address: dallev2 dcorncast.net <br /> Contact Person: Diane Alley <br /> Project Name: Cottage Food Operations <br /> Purchase Order Number: <br /> Quote Number: 11 <br /> Rush Analysis: F] 5 Day[—]4 Day[—]3 Day Ej 2 Day❑24 hoar <br /> Rush pre-approval by lab(initals): <br /> Electronic Data Transfer: E]No❑State Client Other: <br /> sampler(&): <br /> Sampling Fee: Pickup Fee: $ S L <br /> Compositor Setup Date: Time: _ <br /> Samp Location Description Date Timej' i r <br /> Num Sampled Sampled <br /> 1 Wellhead -40-0 'Z0 G DW Src O 1 1 x <br /> Remarks 9unDate: Time: q 'bed ate: Time: Relinquished Date: Time: <br /> E-MAILED <br /> civ By: D e: Time: Received BY: Time: Received$y:._ Date; Time; <br /> / <br /> 11P11-7 l q4,,5 . I� /.7 !I Illi t 2 <br /> Corporate Oflioas A Labor*" O loo&L.ebonftry oflloe a Laboratory Oflloe s Laboratory Olfloe S Laboratory <br /> 853 Corporation$treat 2500 Stageooach Road 583 E.Undo Avenue 3442 Empresa Drive,Suke D 9415 W.Goshen Avenue <br /> Santa Paula,CA 93060 StooMn,CA 95215 Chico,CA 95928 San Luis Obispo,CA 93401 Visalia,CA 93291 <br /> TEL:(805)392-2000 TEL:(209)942-0182 TEL(530)349-5818 TEL:(805)7832940 TEL(559)734-9473 <br /> Env FAX7(905)526-41721 Ag FAX:(806)392-2083 FAX:(209)942-0423 FAX:(530)343-3807 FAX:(806)783-2912 FAX:(559)734-0435 <br /> CA ELAP Certification No,1573 CA ELAP CaTOcation No.1563 CA ELAP Certitieation No,2870 CA ELAP Certfication No.2775 CA FLAP Cartitleallon No.2810 <br />