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ENVIRONMENTAL <br />CHAIN OF CUSTODY <br />AND ANALYSIS REQUEST DOCUMENT <br />Lab Number: <br />/ 9.3453 4 <br />TEST DESCRIPTION AND ANALYSES REQUESTED <br />c"-.6" <br />g , <br />A " . E <br />Field Office <br />Visalia, California <br />TEL: 559/734-9473 <br />Mobile: 559/737-2399 <br />FAX: 6591734-8435 <br />Office & Laboratory <br />2500 Stagecoach Road <br />Stockton, CA 95215 <br />TEL: 209/942-0182 <br />FAX: 209/942-0423 <br />CA ELAP Certification No. 1563 <br />Office & Laboratory <br />563E. Undo Avenuo <br />Chico, CA 95926 <br />TEL: 530/343-5818 <br />FAX: 530/343-3807 <br />CA ELAP Certification No. 2670 <br />Corporate Offices & Laboratory <br />853 Corporation Street <br />Santa Paula, CA 93080 <br />TEL: 805/392-2000 <br />FAX: 805/525-4172 <br />CA NELAP Certification No. 01110CA <br />iaient: Live Oak GeoEnvironmental <br />iQnlamer Number: 3016608 <br />iAddress: 407 W. Oak St. <br />Lodi, CA 96240 <br />I Phone: (209) 369-0375 Fax: <br />Email Address: abbyglogelodi.com <br />Contact Person: Abby Racco <br />Projcct Name: Sandoval, 4845 Harvest Rd., Acampo, CA ), <br />Purchase Order Number: <br />- Quote Number. <br />Sampler(s): jt7P.iy <br />Sampling <br />Compositor <br />Samp <br />Num <br />0 <br />1 <br />Fee: Pickup Fee: <br />Setup Date: Time: <br />Location Description <br />Travel Blank <br />— •:[ <br />I <br />Sampled Sampled <br />Date I Time <br />ahilifi /300 --t i3.00 Domestic Well <br />8 <br />g <br />G <br />3 P <br />X <br />1P130 0 I . X <br />- Potable (P) Non-Potable (NP) Ag g <br />Remarks <br />7 Day RUSH <br />• <br />Relinquished Date: Time: Relin uished Date: Time: <br />‹...2h flo <br />Relinquished Date: Time: <br />GC() <br />Received By: i Daly: Time: <br />'Ili 09 /43 <br />Received By: Date: Time: <br />-747/4- /7c -e <br />Received By: Date: Time: