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ENVIRONMENTAL CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> Lab Number: TEST DESCRIPTION AND ANALYSES REQUESTED <br /> �853�v <br /> Client: Live Oak GeoEnviron mental <br /> Customer Number: 3016608 <br /> Address: 407 W.Oak St. f �' <br /> Lodi, CA 96240 i <br /> Phone: (209)369-0375 Fax: <br /> Email Address: abbyQlogelodi.eom 8 <br /> Contact Person: Abby Racco <br /> Project Name: Marrun, 11851 W. Valpico Rd.,Tracy ?i $. I i 9 _ <br /> Purchase Order Number: <br /> Quote Number. o c Ft <br /> Sampler(s):• <br /> Sampling Fee: Pickup Fee: rm <br /> a y C m to K F x S <br /> Compositor Setup Date: Time: <br /> c3 z <br /> Samp Location Description Irate Time EZ is <br /> t > ti <br /> Num I ( Sampled I Sampled c ro ro �! <br /> � d-a N� r� m .2 0: <br /> 1 Domestic wellfi< jK;� cc,�.h ' G 1 P p DW X <br /> . <br /> 'R U <br /> Remarks Relinquished Date: Time: Re1in uis Date: Time: Relinquished Date: Time: <br /> 7 Da RUSH 411 1553 q �q 1g 1-to GKh <br /> Day g Received By: Dale. Time. Ree ei-od By: q11 <br /> Time: R civcd By: Date: Time: <br /> �rn I1, ' q/�� I� 1553 q 116' GI l , IG( <br /> Corporate Offices a Laboratory Office&Laboratory Office&Laboratory Field Office <br /> 853 Corporation Street 2500 Stagecoach Road 563 E.LindoAvenue Visalia,California <br /> Santa Paula,CA 93060 Stockton,CA 95215 Chico.CA 95926 TEL:559!734-9473 <br /> TEL:8051392-2000 TEL:209/942-0182 TEL:530/343.5818 Mobile:559f737.2399 <br /> FAX:805/525.4172 FAX:209!942-0423 FAX:530/343.3807 FAX:559/734-8435 <br /> CA NELAP Certification No.01110CA CA ELAP Certification No.1563 CA ELAP Certification No.2670 <br />