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.......... <br /> www.fglinc.com CHAIN OF CUSTODY <br /> AND ANALYSIS REQUESTDOCUMENT <br /> Client 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 Fax: (209)982-1009 9 .1Z <br /> Email Address: rramirezS@republicservires.com 3 <br /> Contact Person: Ruben Ramirez <br /> Project Name: <br /> Pbrcb2sc Order Number: 7 8 <br /> Quote Number <br /> Rush Analysis: E] 5 DWE]4 DyE]3 DyF is <br /> 2 Day 24 h... <br /> Rush pre-approval by lab(initals): is <br /> $to <br /> Electronic Data Transfer: [:IN.El state Elm-t other: <br /> Sampler(s): <br /> c <br /> in <br /> Sampling Fee: Pickup Fee: <br /> Compositor Setup Date:_Time: <br /> Satrap <br /> Location Description Date Time <br /> Sampled Sampled <br /> 7_7I 17 <br /> F <br /> I <br /> R-E- <br /> Rerrarits 7 <br /> /1!�Iquished Date-, Time: wished Date Time: RelinquislA Date: The: <br /> X-,eived W, <br /> tc:/ Time: Received Tuue� ei BY. DateTime: <br /> a <br /> 17je'r <br /> Corporate Offices&Laboratory Office&Laboratory Office&Laboratory Office&Laboratory OfflJo&Laboratory <br /> 853 Corporation Street 2500 Stagecoach Road 563 E.Lindo Avenue 3442 Empresa Drive,Suite D 9415 W.Goshen Avenue <br /> Santa Paula,CA 93060 Stockton,CA 95215 Chico,CA 95926 San Luis Obispo,CA 93401 Visalia.CA 93291 <br /> TEL:(805)392-2000 TEL:(209)942-0182 TEL:(530)343-5818 TEL:(805)783-2940 TEL:(559)734-0473 <br /> Env PAX:(805)52-1-4172/Aq FAY:(805)392-2063 FAX:(209)942-0423 FAX:(530)343-3807 FAX:(806)783.2912 FAX:(559)734-8435 <br /> CA ELAP Certification No.1573 CA ELAP Certification No.1563 CA ELAP Certification No.2670 CA ELAP Certification No.2775 CA ELAP Certificaton No.2810 <br />