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`tea` CHAIN OF CUSTODY <br /> ' www.fglinc.com AND ANALYSIS REQUEST DOCUMENT <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 b <br /> Email Address: rramirez5@repubiicservicaes.com <br /> Contact Penton: j uben Ramirez A <br /> Project Name: (! . <br /> Purchase Order Number: jvv" 0 V <br /> Quote Number <br /> Rush Analysis: ® 5 Day®4 Day®3 DayE]2 Day[]24 hour <br /> Rush pmapproval b lab initals. is 44a r <br /> P aPP Y ( ) N <br /> all <br /> `" <br /> Electronic Data Transfer. ®No®State®tint Other: � ,,. 4 <br /> Sampler(s): <br /> Sampling Fee Pickup Fee: <br /> Compositor Setup Date: Time: <br /> Samp Location Description Date Tastes <br /> Num Sampled Sarttpled <br /> F9,5 I <br /> A o,7-4® <br /> e31du a45—A MAO I <br /> Remarks Relinquished Dale: Time: wished � / Dpte: Time: Relvtquished DIC: Time: <br /> R"a te: Time: ZMe—,71A11,1 <br /> k: Time: Rec 'ed QY: Date Time <br /> 7r r,�o� -7U� <br /> caaa <br /> Corporate Offim 6 Laboratory Office d Laboratory Office&Laboratory Office S Laboratory Office 5 Laboratory <br /> 853 Corporation Street 2500 Stagecoach Road 553 E.Undo Avenue 3442 Empresa Drive,Suite D 9415 W.Goshen Avenue <br /> Santa Paula,CA 93080 Stockton.CA 95215 Chico.CA 95928 Sen Luis Obispo,CA 93401 Vlealla.CA 93291 <br /> TEL:(805)392-2000 TEL:(209)942-0182 TEL:(530)343-5818 TEL:(805)783.2940 TEL:(559)7349473 <br /> Env FAX:(805)525-41721Ag FAX:(805)392-2063 FAX:(209)942-0423 FAX:(530)343-3807 FAX:(805)783-2912 FAX:(559)734-8435 <br /> CA ELAP Certification No.1573 CA ELAP Certification No.1663 CA ELAP Certtrication No.2870 CA ELAP Cerpficadon No.2775 CA ELAP Certification No.2810 <br />