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2 <br />0. <br />a <br />G i 2 G <br />G 3 !PIG_ P <br />xi <br />I <br />a Number of Containers . . <br />ate: Time: Re nquished <br />sc) <br />Date: Time: <br />419/9 no 6 <br />Received By:/ Date: Time: <br />140 -",511.9 t7c() <br />R eived By: <br />5e:0( tritne't 3 IA <br />Relinquished Date: Time: <br />//CA-,4 4/1/11 31) <br />Re By: f <br />" , <br />pate, Time: <br />‘Ak, „„ <br />Samp I Location Description <br />Num <br />Travel Blank <br />_ <br />Date Time <br />Sampled Sampled <br />Domestic Well G4/f//9 /3 y <br />_ <br />Remarks <br />7 Day RUSH <br />ENVIRONMENTAL <br />CHAIN OF CUSTODY <br />AND ANALYSIS REQUEST DOCUMENT <br />Lab Number: <br />/9,3‘03-5 <br />TEST DESCRIPTION AND ANALYSES REQUESTED <br />Client: Live Oak GeoEnvironmental <br />Customer Number: 3016608 <br />Address: 407 W. Oak St. <br />Lodi, CA 96240 <br />Phone: (209) 369-0375 Fax: <br />Email Address: abby@logelodi.com <br />Contact Person: Abby Racco <br />Project Name: Patino, 23848 N. Pearl Rd., Acampo, CA <br />Purchase Order Number: <br />Quote Number: <br />Sampled* 7:7" y R,4 <br />Sampling Fee: Pickup Fee: <br />Compositor Setup Date: Time: <br />Corporate Offices & Laboratory <br />853 Corporation Street <br />Santa Paula, CA 93060 <br />TEL: 805/392-2000 <br />FAX: 805/525-4172 <br />CA NELAP Certification No. 01110CA <br />Office & Laboratory <br />2500 Stagecoach Road <br />Stockton, CA 95215 <br />TEL: 209/942-0182 <br />FAX: 209/842-0423 <br />CA ELAP Certification No. 1563 <br />Office & Laboratory <br />563 E. Undo Avenue <br />Chico, CA 95926 <br />TEL: 530/343-5818 <br />FAX: 530/343-3807 <br />CA ELAP Certification No. 2670 <br />Field Office <br />Visalia, California <br />TEL: 559/734-9.473 <br />Mobile: 559/737-2399 <br />FAX: 559/734-8435