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'—MG i E- __71 CHAIN OF CUSTODY <br /> • www.fgl inc.com AND ANALYSIS REQUEST DOCUMENT <br /> Client: Live Oak Geo Environmental Lab Number: TEST DESCRIPTION AND ANALYSES REQUESTED <br /> Customer Number: 3016608 <br /> Address: 407 W.Oak Street <br /> Lodi, CA 95240 <br /> Phone: (209)369-0375 Fax: (209)369-0375 <br /> Email Address: welchlodi(a)vahoo.com <br /> Contact Person: David Welch <br /> Project Name: V_C-;V%W0L+("e- <br /> Purchase Order Number: y <br /> Quote Number: <br /> Rush Analysis: [—] 5 Day[—]4 Day E]3 Day❑2 Day❑24 hour E <br /> Rush pro-approval by lab(atitah): <br /> Electronic Data Transfer: El No❑State 0C&ent Other: <br /> m <br /> a <br /> Sampling Fee: Pickup Fee: <br /> Compositor Setup Date: Time: <br /> Samp Location Description Date Time Y � �► g '� <br /> Num Sampled I Sampled <br /> Ieaitiwoekv 40-1 W• 5;-11-11 G:iso wi G 1 Q X <br /> vAA S-1., Lod: <br /> Remarks Relinquished Date: Time: Relinquish Date: Time: Relinquished Date: Time: <br /> 1*444 - S a y II' ID <br /> Receiv Date: Time: R e DI: Time: Received By: Date: Time: <br /> Corporate Offl es a Lebow tatty Offfoe 6 Laberatmy office&taberabon y Doles 6 Laboratory ORlas 6 Labovalsmy <br /> 803 Corporation Street 2600 Stapsoosch Rood 583 E Undo Avenue 3442 Empresa Drive.Suite D 9418 W.Goshen Avenue <br /> Santa Paula,CA 93080 Stoddm CA 96215 Chloe,CA 95928 San Lala Obispo,CA 93401 Via"CA 93291 <br /> TEL:(806 992-2000 TEL:(209)942-0182 TEL:(530)343-5818 TEL'(805)783-2940 TEL(339)734-9473 <br /> Em FAX:(805)626-4172!AV FAX(806)392-2083 FAX:(209)942.0423 FAX:(630)343-3807 FAX:(805)783-2912 FAX(539)73448435 <br /> CA ELAP Certification No.1573 CA ELAP Cer00eation No.1553 CA ELAP Cer6flesbon No.2670 CA ELAP certification No.2775 CA ELAP CaMpeatiat No.2810 <br />