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_ _ CHAIN OF C USTOD Y <br /> 3� ENVIRONMENTAL AND ANALYSIS REQUEST DOCUMENT <br /> Lab Number TEST DESCRIPTION AND ANALYSES REQUESTED <br /> 2o �tZ� _ <br /> Client: Live Oak GeoEnvironmental <br /> Customer Numbcr: 3016608 I <br /> Address: 407 W. Oak St. <br /> Lodi,CA 96240 ` <br /> Phone: (209)369-0375 rax: _ <br /> Email Address: abbyQlogelodi.eom <br /> Contact Person: Abby Raceo !§o $ o <br /> Project Name:Rose,3511 Jamie Ct.,Acampo,CA n <br /> Purchase Order Number. 9 o g ✓` <br /> Quote Number. o a <br /> r <br /> o Z I✓ RUSH, <br /> Sampler(s): = g P— `t-g <br /> Sampling Fee: Pickup Fee: F g Li N^ N 0 o z <br /> d S <br /> Compositor Setup Date: _ Tim r _ g a d v N E t <br /> V <br /> Samp Location DescriptionDai tmc N tt A 1 <br /> Num ed Sampled z' r r'n r- <br /> 0 Travel Blank 10:3 o G 2 G X <br /> 1 Domestic Well lz-y-79 to:3a G 3 PIG P DW SRC O 1 X X <br /> Remar S Relinquished Date: Time: clinquishe, ate:: Time: Relinquished Date: Time: <br /> 'ent Y UQ-S+ /1�,., ,� �n Iz 1'57 / �iv ►3:00 <br /> 7 Day R US O � ' u <br /> Received By: Date: Time: Received By: Dete: Time: Rec6v By: Dak: Time: <br /> ^ (420 56t) <br /> Corporate Offices&Laboratory Office&Laboratory OHlce&La r tory Field ee <br /> 853 Corporation Street 2500 Stagecoach Road J 563 E.Undo Avenue Visalia,California <br /> Santa Paula.CA93060 Stockton.CA 95215 Chico.CA 95926 TEL:559/734-9473 <br /> TEL:805/392-2000 TEL:209/942-0162 TEL: /343-5818 Mobile:559/737-2399 <br /> FAX:805/525-4172 FAX:209/942-0423 FAX: 0/343.3807 FAX:559!734.8435 <br /> CA NELAP Certification No.01110CA CA ELAP Certification No.1563 C LAP Certification No.2670 <br /> slew <br /> �VK11 <br />