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CHAIN OF CUSTODY <br /> %W11 <br /> ENVIRONMENTAL AND ANALYSIS REQUESTDOCUMENT <br /> b Number, TEST DESCRIPTION AND ANALYSES REQUESTED <br /> F �0 <br /> 3� <br /> Client: Live Oak Geo Environmental <br /> Customer Number: 3016608 <br /> Ada""': 407 W.Oak St. <br /> Lodi, CA 96240 <br /> Phone: (209)369-0375 Fax: �F <br /> Email Address: abby@logelodi.eom ' <br /> Contact person: Abby RaccoR 0 8 I <br /> Project Name:Affonso, 1424 S.Jack Tone Rd.,Stockton 11 g <br /> 1 3 U <br /> Purchase Order Number. <br /> t? o e g 0 8 <br /> Quote Number: O & <br /> Samplcds): <br /> 3 �y o <br /> Sampling Fee: _ _-- _ Pickup Fce: 0 a= <br /> Compositor Setup Date: Time: h z ti E g� -7 e' <br /> 51 <br /> Samp location Description Date Time <br /> Num I ( Sampled I Sampled f :2 r a w t�i aScl to a <br /> 0 Travel Blank -LU•7.0 i o:t.} G 2 G X <br /> 1 Domestic Well 24 W-4� G 3 P/G P DW SRC O X X <br /> c r. <br /> .i <br /> Remarks � �i ` � ,'J L� � Relin ed Date: Time: Relinquished Date: Time: Relinquished Dat Time: <br /> 05-210-70 5410ib Ila <br /> YReceive By: Date: Time: Received By: Time: Received By: Date: Time: <br /> l� 5 ?b 1(0 V, Ala IZD) L) <br /> Corporate Offices&Laboratory Office&Laborato OHlce Laboratory Field Office <br /> 853 Corporation Street 2500 Stagecoach Road 563 E.Lindo Avenue Visalia,California <br /> Santa Paula,CA 93060 Stockton,CA 95215 Chico,CA 95926 TEL:55917 34-94 73 <br /> TEL.805!392-2000 TEL:2091942-0182 TEL:530/343.5818 Mobile:5591737-2399 <br /> FAX:805/525,4172 FAX:209/942-0423 FAX:53 0134 3-360 7 FAX:5591734.8435 <br /> CA NELAP Certification No.01110CA CA ELAP Certification No.1563 CA ELAP Certification No.2670 <br />