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I nal <br /> ENVIRONMENTAL AND <br /> OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> Lab Number: TEST DESCRIPTION AND ANALYSES REQUESTED <br /> '�X325 <br /> Ment: Live Oak GeoEnvironmental i <br /> Xiastemer Number- 3016608 <br /> Aatltes:: 407 W.Oak St. I I <br /> Lodi,CA 96240 1 g t <br /> Phone: (209)369-0375 Fax <br /> EmaihAddress: abby@logelodi.com 1 I ! <br /> contact Person: Abby Raoco <br /> Pro act Name:Gomez,3809 E.Emerson,Acampo,CA q j <br /> Purchase Order Number: <br /> Quote Numbero = <br /> . 9 I • <br /> i <br /> StuopkAs): r—� Ge C)4[nom , " �, '3�: g � ; <br /> ON X bi e, m I 5 <br /> Z3 $ Zz <br /> Z' I <br /> Sampling Fee: -_ Pickup Fee: m y , , rn I x,Q <br /> Z <br /> Compositor Setup Date: Time: <br /> � F 7 <br /> 1• <br /> p , 2 <br /> g Samp Location Description Date Time <br /> Numi <br /> I Smnpled I_.Sampled <br /> _. <br /> 0 Travel Blank 1*V G 2 GX --- -• <br /> - - - <br /> - <br /> {-1 Domestic Well i��-�9 I /EGD r G 3 P/G P DW SRC O ' X X <br /> r , <br /> I ; <br /> 1 <br /> .-.. l <br /> U� S- <br /> - <br /> . <br /> Remarks Relinquished Date: Time: elfin Date: Time: Relinquished Date: Time: <br /> 7 Day RUSH <br /> Received Date: Time:09L II Dat Time: ,` Received By: Date: Time: <br /> 5� iy I�3 JW- <br /> Corporate <br /> Corporate Offices&Laboratory Office&L6boratory Office&Laboratory Field Office <br /> 853 Corporation Street 2500 Stagecoach Road 563 E.Linda Avenue Visalia,California <br /> Santa Paula,CA 93060 Stockton,CA 95215 Chico,CA 95926 TEL:559/734-9473 <br /> TEL:8051392.2000 TEL:2091942-0182 TEL:5301343.5818 Mobile:55917 3 7-2 3 99 <br /> FAX:805/525-4172 FAX:2091942-0423 FAX:5301343-3607 FAX:5591734-11435 <br /> CA NELAP Certification No.01110CA CA ELAP Certification No.1563 CA ELAP Certification No.2670 <br />