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Special <br />CHAIN OF CUSTODY <br />www.fglific.com <br />Customer Copy (2 of 3) <br />11111 111 1111111 11 1111 11 11 35730.02/06/2017 <br />., , <br />TEST DESCRIPTION - See Reverse side for Container, Preservative and Sampling information <br />Client: San Joaquin County EHD :- <br />Address: San Joaquin Co. Environmental Health 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: MC °\0\ C-j9 t.t ..te• \WV\ " <br />Purchase Order Number: me i.,14 c ,,, CA el S <br />Quote Number: ST 20160309-01 Method of Sampling: Composite(C) Grab(G) Type of Sample **SEE REVERSE SIDE** Location Descriptionn. 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) <6 <br />t <br />'8 <br />Y <br />a"- <br />t..,) — <br />Time <br />00 <br />- <br />14, 8 <br />8 z <br />Tti fl:- <br />(.7 rsi <br />o <br />tu <br />A ..-1 0 = <br />u4 <br />a. <br />n z <br />..7'1'., <br />El', li <br />ir., ::: <br />. i r <br />O. <br />r.1.. <br />P <br />O. <br />tl.. <br />Sampler(s) <br />Sampling <br />Compositor <br />(911/4(1-4, +.,V,k,. <br />Fee: Pickup Fee: <br />Setup Date: / Time: /-) <br />Lab Number: S K 3-17919 T <br />Samp <br />Num <br />Date <br />Sampled Sampled <br />1 G DW 1 1,1,1 <br />Remarks: Relinquished Date: Time: <br />r ) <br />Relinquished Date: Time: Relinquished Date: Time: <br />Received By:i Date: Time: <br /> <br />1,14 ii i t . . , <br />Received By: Date: Time: Received By: Date: Time: <br />Coroorate Offices & Laboratory Office & Laboratory Office & Laboratory Office & Labora ory Office & Laboratory <br />853 Corporation Street 2500 Stagecoach Road 563 E. Lindo 3442 Empresa D ive, 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