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ENVIRONMENTAL `"� U CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> TEST DESCRIPTION AND ANALYSES REQUESTED <br /> i.Clicar Live Oak GeoEnvironmental - - <br /> 'CuslornerNumber. 3016606 <br /> ;Address: 407 W.Oak St. <br /> Lodi,CA 96240 <br /> Phone: (209)369-0375 Faz: <br /> Email Address: abby@logelodi.com <br /> Contact Pcrsoa: Abby Racco <br /> Pmjrn Name:Dambacher,27445 N. New Hope,Thomtorn <br /> Purchase Order Number. <br /> _ :. _ € <br /> Quote Number: x� � O <br /> Sampler(s): <br /> Sampling Fee: Pickup Fee: <br /> Composilor Setup Data. Time; <br /> Samp Location Description Date --Time g y 'd <br /> S p§ <br /> NumI I..Semplcd I Sampled <br /> 0 Travel Blank l-Io 4 (e:ej G 2 G X <br /> 1 Domestic Well )-10-18: 0'61 G 3 P/G P DW SRC O 4 X X <br /> Remarks Re li rshod D/ Date. Time- Relinquished Data; Time: R m: Time: <br /> 7 Day RUSH Received Time: Rovema m: Time: Received By: r Time: <br /> UUr�f/io!/Y Ott d /o 1.57- r� 8 I7dZ� <br /> Corporate OfBeea 6 Laboratory Office E Laboratory Office 8 Labor t ry Field Oalce <br /> 853 Corporation Sunni 2500 Stagecoach Road 563 E.Llndo Av a Yrsalie,California <br /> Senle Paula,CA 93080 SloeMon,CA 95215 Chico,CA 9592 TEL:5591734-9473 <br /> TEL:805/392-2000 TEL:209/942-0182 TEL:530/343- Mobile:559/737-2399 <br /> FAX 805/5254172 FAX:209/942-0423 FAX:530/343- FAX:5597734-8435 V`1 <br /> CA NELAP CadrkaW No.01110CA CA ELAP Certification No.1563 CA ELAP Curti No.00J <br />