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<br />CHAIN OF CUSTODY <br />AND ANALYSIS REQUEST DOCUMENT <br /> <br />,G11- <br />ENVIRONMENTAL ACIRICULTURAL <br /> <br />www.fglinc.com <br /> <br />Amilyticol Chi:1116U; <br /> <br />Client: Live Oak Geo Environmental <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: welchlodiavahoo.com <br />Contact Person: David Welch <br />Project Name: C1239b w. &raywci rv2_, —169..c.1 . <br />Purchase Order Number: <br />Quote Number. <br />ICilYC) <br />Lab Number:TEST DESCRIPTION AND ANALYSES REQUESTED <br />i 1 <br />ii <br />11 <br />li <br />II <br />8 <br />11 <br />Kg (S) Sell (SLO) Sludge (SW) Sold (0) 02 i <br />€ <br />i <br />I <br />1 1 Batt (ROUT)Routine (RPT)Repeet (OTtipther (RPL)Replece I I(Li) Led Tissue (PET) Petiole Tissue (PRO) Produce 2 <br />gEta <br />0 16 <br />ii <br />i <br />I I 1 Method of Sampling Composite (C) Grab (G) "a <br />1 Type of Con Others: (G)Clises (P)Ptastic (V)V0A (Ml)igteiel Tube I 1 i <br />1 <br />8) <br />k <br />g <br />i <br />i <br />Rush Analysis: fl5 Day 4 Day 3 Day 2 Day 24 hour <br />Rush pre-approval by lab (initals): <br />Electronic Data Transfer: No State Client Other: <br />I <br /> Sampler(s): <br />Sampling Fee: Pickup Fee: <br />Compositor Setup Date: Time: <br />Samp <br />Num <br />Location Description Date I <br />Sampled <br />Tane sample <br />Sampled <br />[ DON. 4 IC, \NOt 141t)llq 111 C C9 ) <br />1 <br />Remarks <br />. <br />Relinquished Date: Time: I <br />) <br />6 4420 9 <br />4 \1 \101 <br />Relinquished Date: Time: Relinquished Date: Time: <br />\I"fE° (-40 <br />Receiv Tim /Date: r oir <br />zilihq 0P-- <br />ed By: late: <br />4 illq <br />Time: Received By: <br />n'19° (p\f-(, 1-1(21 14 <br />Date i Time: <br />KO) <br />Corporate Offices a Laboratory <br />853 Corporation Street <br />Santa Paula, CA 93080 <br />TEL (805)392-2000 <br />Env FAX: (605)525-4172 / Ag FAX: (805)392-2083 <br />CA ELAP Certification No.1573 <br />Office & Laboratory <br />2500 Stagecoach Road <br />Madden, CA 95215 <br />TEL: (209)942-0182 <br />FAX: (209)942-0423 <br />CA ELAP Certritcation No. 1563 <br />Office & Laboratory <br />563 E. Undo Avenue <br />Chico, CA 95928 <br />TEL: (530)343-5818 <br />FAX: (530)343-3807 <br />CA ELAP Certification No. 2670 <br />Office & Laboratory <br />3442 Entpresa Drive. Suite D <br />San Luis Obispo, CA 93401 <br />TEL (805)783-2940 <br />FAX: (805)783-2912 <br />CA ELAP Certification No. 2775 <br />Office & Laboratory <br />9415 W. Gotshen Avenue <br />Visatia, CA 93291 <br />TEL: (559)734-9473 <br />FAX: (559)734-8435 <br />CA ELAP Certification No. 2810