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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: welchlodi(Mvahoo.eom J— <br /> V. <br /> Contact Person: <br /> David Welch `n <br /> Project Name: b Z <br /> Purchase Order Number: ... <br /> Quote Number: <br /> Rush Analysis: 05 Day❑4 Day❑3 Day 2 Day E]24 hour <br /> Rush pre-approval by lab(mitab): ST <br /> Electronic Data Transfer. 11 No 0 State ❑l:'litttt Other: � q <br /> Sampler(s): o r✓+ _ <br /> � .. 8 <br /> Sampling Fa: Pickup Fee: �: a <br /> Compositor Setup Date: Time. $ 1— 3 F F <br /> Samp Location Description Date Time <br /> Num Sampled Sampled <br /> 12a; w�.-F�✓ 5-I'1-i9 S: uo G Q <br /> Remarks Retinqu' ed Date: Time: Relinquished Date: Time: Relin fished Date: on,: <br /> Received By Date: Time: Receiv D te: Time: Rcc 'ed 3y: Dat Time: <br /> nov <br /> )n- <br /> Oerporaft onto"a Laboratory oMoe a Laboratory oil!"a one.a Laboratory oRl"a Laboratory <br /> S53 Corporation Street 2500 Stagecoach Road 563 E Undo A 3442 Empresa Dive.Sufte D 9415 W.Goshen Avenue <br /> Santa Petda.CA 43080 StodCas,CA 95215 C4400.CA I(b'C(g.Luta Oblapo.CA 93401 Vls"CA 93291 <br /> TEL(805)392-2000 TEL:(209)942-0162 TEL:(530) 18 1 EL:(805)783-2940 TEL:(559)734-9473 <br /> Em FAX:(805)525-4172/Ag FAX:(805),192-2083 FAX:(209)942-0423 FAX:(530),143=7 FAX:(805)783.2912 FAX:(5!0734.8435 <br /> CA EIAP Cet51fe89M No.1573 CA FLAP CettMttxtlan No.1563 CA E L No. (3 CA ELA?cerwxagm No.277s CA EMAP Cert1flosbon No.2810 <br />