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CHAIN OF CUSTODY <br /> ® WWW fg ZZ72C.CO1�fZ AND ANALYSISREQUEST DOCUMENT <br /> Ciient: Forward Inc. Lab Number: TEST DESCRIPTION AND ANALYSES REQUESTED <br /> Customer Number 3008692 <br /> Address: Ruben Ramirez / <br /> 9999 S.Austin Rd <br /> Manteca,CA 95336 <br /> Phone: (209)982-4298 Far: (209)982-1009 F m <br /> Email Address: rramirez5@republicservices.com a m m <br /> m 3 cd <br /> Contact Person: uben Ramirez r � <br /> Project Name: a) <br /> tom, <br /> Purchase Order Number: i � s <br /> a <br /> Quote Number: <br /> Sr+ m A <br /> Rush Analysis: ❑ 5 Day®4 Day®3[lay®2 Day[]24 flour 'q <br /> 40 <br /> Rush pre-approval by lab(inhats): <br /> Electronic Data Transfer: ®No®State ®Client Other: <br /> 0 .+ ln: <br /> F1 a' Z. <br /> Sampler(s): m m �; <br /> a V <br /> m f <br /> rN <br /> Sampling Fee. Pickup Fee: <br /> o'Tar <br /> Compositor Setup Date: Time. £ p�p. f„ ru <br /> Samp Location Description Date Time <br /> Num Sampled Sampled <br /> IF <br /> i �'J CGCG `7 C /�Z ✓ l�$Gf L� I I r <br /> ks 1AF— <br /> Relinquished Date: Time: Rel' iched Date: Tone: Relinquished Date: Time: <br /> ed Sy: Date Time: Received By: Plate: y Time: Received By C,Date: f Time: <br /> �/A A/ <br /> Corporato Offices&Laboratory Office&Laboratory Office&Laboratory Office/&Laboratory i ) afeco&Laboratory <br /> 853 Corporation Street 2500 Stagecoach Read 563 E.Undo Avenue 3442 Empresa Drive,Suite D 9a15 W.Goshen Avenue <br /> Santa Paula,CA 93060 Stockton,CA 95215 Chico,CA 95928 San Luis Obispo,CA 93401 Visaila,CA 93291 <br /> TEL:(805)392-2000 TEL;(209)942-0182 TEL:(530)343-5818 TEL:(805)783-2940 TEL:(559)734-9473 <br /> Env FAX:(605)525-4172/Ag FAX;(805)392.2063 FAY:(209)942-0423 FAX:(530)343-3807 FAK(805)783-2912 FAX:(559)734-8435 <br /> CA ELAP Certification No.1573 CA FLAP Certification No.1.563 CA FLAP Certification No,2670 CA FLAP Certification No.2775 CA ELAP Certification No.2810 <br />