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CHAIN OF CUSTODY <br /> =- KjRICUL'FURAL www.fglinc.com AND ANALYSIS REQUEST DOCUMENT <br /> Client: Live Oak Geo Environmental b Number: TEST DESCRIPTION AND ANALYSES REQUESTED <br /> Customer Ntunba: 3016608 O <br /> Address: 407 W.Oak Street <br /> Lodi, CA 95240 <br /> Phone: (209)369-0375 Fax: (209)369-0375 <br /> Email Address: welehlodiO..vahoo.com " <br /> A <br /> Contact Person: David Welch <br /> Project Name: N <br /> Z <br /> Purchase Order Number: <br /> Quote Number: <br /> Rush Analysis: ❑ 5 Day 0 4 Day❑3 Day❑ 2 Day❑24 hour E <br /> Rash pre-approval by lab(mitals): <br /> Electronic Data Transfer: No ED State Client Other: <br /> Samp"s) m <br /> Sampling Fa: Pickup Fee: �$ 8 <br /> Compositor Setup Date: Terse:. _ <br /> Samp Location Description Date Time <br /> Num Sampled Samp)cd <br /> Remarks Relmqu' ed Date: The: Reletquished Date: Time: Relin 'he' <br /> Date: Time: <br /> Received By: ^ Date: Tine: Receiv Die: Terse: Ra ' ed By Dat Time: <br /> 1 <br /> Corporate Offices a Laeore twy OMes a Lsbm bwy Olflw a Office a Labors" Ofllee a Laborelory <br /> 653 Corpwetlon Street 2500 Stegeooeeh Road 563 E Un A 3442 Empreeo Dd",Suite D 8415 W.Goshen Avon" <br /> Sertts Pada.CA 93080 StodtMn.CA 95215 Chfoo,CA 95 1,61 Ude Obispo,CA 93401 Vitu fl4 CA 83.291 <br /> TEL:(605)392-2000 TEL:(209)942-0182 TEL:(630) 18 iEL:(905)783-2940 TEL(659)734-9473 <br /> Env FAX:(805)525-11 T2/Ag FAX:(866)392-2003 FAX:(209�t2.0423 FAX:(530)343-M7FAX:(805)783-2912 FAX(659)7348435 <br /> rtlflEI <br /> CA ELAP Ceeallon No. M CA RP C01.11--n No.1563 CA FLAP No. 13"7-'CA ELAP Cerifflea tion No.2775 CA ELAP CeRGfeedw No.2810 <br />