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CHAIN OF CUSTODY <br /> www.fglinc.com AND ANALYSIS REQUEST DOCUMENT <br /> Client: Live Oak Geo Environmental b Number: TEST DESCRIPTION AND ANALYSES REQUESTED <br /> Customer Number: 3016608 O <br /> Address: 407 W.Oak Street <br /> Lodi, CA 95240 <br /> Phone: (209)369-0375 Fax: (209)369-0375 <br /> Email Address: welehlodi(cD.vahoo.eom <br /> A <br /> Contact Person: David Welch <br /> Project Name: O Z <br /> Purchase Order Number: <br /> Quote Number: <br /> Rush Analysis: El 5 Day E]4 Day❑3 Day 2 Day 24 hour XI E <br /> Rush pre-approval by lab(initab): a <br /> Electronic Data Transfer. E]No E]State F—]Ctirnt <br /> Other: <br /> VN <br /> p � <br /> _ 8 _ • �� <br /> Sampling Fee: Pickup Fee: $ 1 <br /> Compositor Setup Date: Time: $ H F <br /> Samp Location Description Date Time <br /> Nutri Sampled Sampled <br /> Remarks Rehnqu' ed Date: Time: Relinquished Date: Time: Relin 'hed Date: Time: <br /> Received By Date: Time: Receiv D to: Time: Rec 'ed By: Dat Time: <br /> Owperrb OMoes a LaberMe" OR%*a Laboratory onloo a O!lloe a Labwebwy of m a Laboratory <br /> 853 Corporebon Serest 2500 Stepecoach Road F4304 <br /> A 3442 Empresa Orl",Sulte D 9415 W.Goshen Avenue <br /> Sento Panda,CA 03080 Stockton.CA 95215 I(olt L ft pbtapo,CA 93401 VlsaBa,CA 93291 <br /> TEL•(805)392-2000 TEL:(209)042-0182 18 t iEL:(805)783 2940 TEL(559)734-9473 <br /> Env FAX:(805)525.4172 f Ag FAX:(805),792-2083 FAX:(209)942-0423 FAX:(530}143-3807 /,FAX:(805)7812912 FAX:(559)734-8435 <br /> CA EIAP Cer0o0on No.1573 CA EIRP Cert ocaffon No.1553 CA FLAP No. (3"�'CA ELAP Certlfte�on No.2775 CA ELAP Certl5ee8ort No.2810 <br />