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LAM <br /> Mat CHAIN OF CUSTODY <br /> ENV1R• www.fgl inc.com AND ANALYSIS REQUEST DOCUMENT <br /> Aoalylicall Chemists <br /> Client: Matt Shinn Lab Number: TEST DESCRIPTION AND ANALYSES REQUESTED <br /> Customer Number: 3016964 D9i3 <br /> Address: 21770 N.Davis Rd. <br /> Lodi,CA. 95242 <br /> m <br /> Phone: (209)365-9117 Fax: <br /> a <br /> FinaO Addres:: CL <br /> mdshinn a()..hotmail.com <br /> Contact Person: 1Matt Shinn 7�-, <br /> Project Name: +�p GU !k 1C7L`� �C (7 Q�Q O C <br /> Purchase Order Number. <br /> Quote Number. �y 6 <br /> Rush Analysis: 5 Day❑4 Day E]3 Day❑2 Day 24 hour m $ O 0 y E <br /> Rush pre-approval by lab(atilalt): It <br /> m <br /> Electronic Data Transfer: 11 No❑State Client Other: v <br /> f_ <br /> Sampler(s): co <br /> 8 ° = =F <br /> Sampling Fee: Pickup Fee: <br /> Compositor Setup Date: Time: <br /> Samp Location Description DateTime <br /> Num Sampled Sampled <br /> 0 ) <br /> Remarks Relinquished Date: Tarte: wished ate Time: Ref 'led Date: Time: <br /> /o: / i7 t 9 /7a� 40 1 <br /> gxer'ved-7Date: Time: Received By: Dat : Time: iv Date: Time: <br /> Corporab Oetoea a Laboratory O!!lu 6 Laboratory Office&Laboratory Offloe&Laboratory cs S ry <br /> 853 Corporation Street 2500 Stagecoach Road 563 E.Undo Avonuo 3.442 Empresa Drive,Suite D 94 5 W. Avenue <br /> Santa Peufa,CA 93080 Stoddon,CA 95215 CMoo,CA 95926 San Luis Obispo,CA 93401 Visalia,CA 93291 <br /> TEL(805)392-2000 TEL:(209)942-0182 TEL:(530)3435818 TEL:(805)783-2940 TEL(559)7349473 <br /> Env FAX:(805)625.4172/Ag FAX:(806)392-2063 FAX:(209)942-0423 FAX:(530)343-3807 FAX:(805)783.2912 FAX:(559)734-8435 <br /> CA ELAP Cer06cation No.1673 CA ELAP Certinoation No.1563 CA ELAP Certification No.2670 CA ELAP Certification No.2776 CA ELAP Certification No.2810 <br />