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Special <br />Analytical Chemists <br />CHAIN Or CUSTODY <br />www.fglinc.com <br />Customer Copy (2 of 3) <br />II 1 111 II 1111 II Mil 1 35731:02/06/2017 TEST DESCRIPTION See Reverse side for Container, Preservative and Sampling information <br />Client: San Joaquin County EHD <br />Address: San Joaquin Co. Environmental Hdalth Dep <br />Water Quality Division <br />Attn: Rodney Estrada <br />1868 East Hazelton Ave. <br />Stockton, CA 95205 <br />Phone: (209)468-0331 Fax: <br />Contact Person: Rodney Estrada <br />Project Name: \ \ 0 °0\ .tv C.0 \kW. \6,14 a <br />Purchase Order Number: IN <br />IO-t(t• Ck RS3 V17 <br />Quote Number: ST 20160309-01 Method of Sampling: Composite(C) Grab(G) Type of Sample **SEE REVERSE SIDE** Potable(P) Non-Potable(NP) Ag Water(AgW) Bacti Type: Other(0) System(SYS) Source(SR) Waste(W) Bacti Reason: Routine(ROUT) Repeat(RPT) Replace(RPL) Other(0) Special(SPL) EPA 504.1-DBCP Only 40m1(VOA) Sampler(s) <br />Sampling <br />Compositor <br />.4 ,) <br />k>tf4., <br />Fee: Pickup Fee: <br />Setup Date: / / Time: / <br />Lab Number: STK 3-17919 <br />Samp <br />Num Location Description Date <br />Sampled <br />Time <br />Sampled <br />0 Travel Blank ill IU'l \ - G LBW / 2- <br />1 1.141toq 1 G DW 4 <br />Remarks: <br /> <br />Relinquished Date: Time: <br />(..)." i <br /> <br />. 4"7- 3iyilli 1179 <br />) <br />Relinquished Date: Time: Relinquished Date: Time: <br />Received By:i yate: Time: <br />bi)V1 ?) ILI I/ 1 1762 <br />Received By: Date: Time: Received By: Date: Time: <br />Corporate Offices & Laboratory Office & Laboratory Office & Laboratory Office & Laboratory Office & Laboratory <br />853 Corporation Street 2500 Stagecoach Road 563 E. Lindo 3442 Empresa Drive, Suite D 9415W. Goshen Avenue <br />Santa Paula, CA 93060 Stockton, CA 95215 Chico, CA 95926 San Luis Obispo, CA 93401 Visalia, CA 93291 <br />Phone: (805) 392-2000 Phone: (209) 942-0182 Phone: (530) 343-5818 Phone: (805) 783-2940 Phone: (559) 734-9473 <br />Env Fax: (805) 525-4172 / Ag Fax: (805) 392-2063 Fax: (209) 942-0423 Fax: (530) 343-3807 Fax: (805) 783-2912 Fax: (559) 734-8435