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CHAIN OF CUSTODY <br /> www.fgl inc.corn AND ANALYSIS REQUEST DOCUMENT <br /> Client: Dwight J.Busalacchi Lab Number::/ TEST DESCRIPTION AND ANALYSES REQUESTED <br /> Customer Number. 3017015 <br /> Address: 8075 Wavland Rd <br /> Loomis,CA 95650 <br /> Phone: (415)531-6450 Fax: <br /> Email Address: dvrightb(aa)miovigneto.eom <br /> Contact Person: DWiaht J.Busalacchi <br /> Projcc,Name: <br /> 1646767. <br /> Purchase Order Number: <br /> Quote Number: �dS <br /> Rush Analysis: 5 Day�4 Day�3 Day❑2 Day 24 hour a p E <br /> pp � o € a . <br /> Rush pre-approval by lab(viitab): v <br /> Electronic Data Transfer: 0 No State []Ctirnt Other: <br /> d) <br /> Sampler(s): <br /> Sampling Fee: Pickup Fee: r3 t Ig <br /> Compositor Setup Date: Time: �$ _ <br /> Samp Location Description Date Time �^ Ig o �1 <br /> Num Sampled Sampled <br /> -�rcw4L f3(a0K3/71 1160 C-1 Z <br /> 7 l9 Ile D L O 2 <br /> FF <br /> Remarks Relinquished Date: Time: R ishcd Date: Time: Relinquished Dote: Time: <br /> -706 <br /> R Date: Time: Received By: Date: Time: R eived BY: ate: Time: <br /> IN/9 (� 3 I2� <br /> corporate Offices a Laboratory Office 8,Lebo rntory Otttas 6 Laboratory onto•&Laboratory Office 6 Laboratory <br /> 853 Corporation Street 2500 Stageooeeh Road 583 E.Undo Avenue 3442 Empresa Drive.Suite D 9415 W.Goshen Avenue <br /> Saha Patch,CA 93080 Stockton,CA 95215 Chloo,CA 95920 Sen Luis Obtspo,CA 93401 Visalia,CA 93291 <br /> TEL(805)392-2000 TEL:(209)942-0182 TEL(530)3435818 TEL:(805)7832940 TEL.•(559)734-9473 <br /> Erry FAX(805)525-4172/Ag FAX(805)392-2083 FAX:(209)942-0423 FAX:(530)3433807 FAX:(805)7832912 FAX:(559)734-8435 <br /> CA ELAP Certifleetbn No.1573 CA ELAP Certification No.1663 CA ELAP Certification No.2670 CA ELAP Certification No.2775 CA ELAP Certification No.2810 <br />