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www.fglinc.com <br />CHAIN OF CUSTODY <br />AND ANALYSIS REQUEST DOCUMENT <br />Client; aU eALab Number: <br />Customer Nur: k <br />3 -f I iS 0 2 *OZ9 co <br />Address: `—I --x0 0 A\ <br />Office & Laboratory <br />2500 Stagecoach Road <br />TEST DESCRIPTION AND ANALYSES REQUESTED <br />Office & Laboratory <br />3442 Empresa Drive, Suite D <br />Santa Paula, CA 93060 <br />Stockton, CA 95215 <br />Chico, CA 95926 <br />San Luis Obispo, CA 93401 <br />TEL: (805)392-2000 <br />TEL: (209)942-0182 <br />TEL: (530)343-5818 <br />TEL: (805)783-2940 <br />Env FAX: (805)525-41721 Ag FAX: (805)392-2063 <br />CA ELAP Certification No. 1573 <br />FAX: (209)942-0423 <br />CA ELAP Certification No. 1563 <br />FAX: (530)343-3807 <br />CA ELAP Certification No. 2670 <br />FAX: (805)783-2912 <br />CA ELAP Certification No. 2776 <br />ko'-h�t e -N 0 <br />Phonc:((6Sa) ZR 31 Fax:CL <br />Email Address: PA(? ee-kj�wMQ. Ca,,,, <br />Contact Person: ,1` CVpVa4S <br />Project Name: &4AF 91cC%A- h C� �tf C� t� a <br />Purchase Order Number: <br />Quote Number: <br />Rush Analysis: 5 Da 4 Da 3 Da 2 Day 24 hour <br />❑ y❑ y D Day ❑ <br />Rush pre -approval by lab (initals): <br />Electronic Data Transfer. 0 No 11 State El Client Other:99�� <br />Sampler(s): `� <br />E <br />U <br />Sampling Fee: Pickup Fee: <br />Compositor Setup Date: Time: <br />Samp Location Description Date Time, <br />Num Sampled Sampled <br />,pp� <br />Z <br />$ <br />E ' C <br />oe <br />.r <br />H <br />$ <br />o <br />m <br />" <br />€ <br />n <br />m <br />p <br />y <br />v <br />iF <br />m <br />♦ <br />^ <br />t <br />{,\Yt{ V <br />Q <br />t <br />i <br />�� <br />Irk` <br />,W► OQ <br />\0 Z za <br />-1 /' to C. <br />3 GN G <br />t� <br />�• 3� <br />'� <br />emarks C44 -M V+ - �� e a5z VAID6L Re ' uished Date: Time: <br />525�0 s ►�5i.�� . �P o; <br />CLt tIt ez rp4t <br />�F � l �I <br />O ?cJ%!� <br />L c�c� �1u5W1'S tx'� 1tsS{lia'n Ito <br />TC) .- ��, miarvr7 pwrN COL^ l"3` Rece' ed By: Date: Time: <br />t11�d�P2.1 <br />DI- 0 8 D I �l v <br />s� <br />Relinquished Date: Time: <br />l D ?.� <br />2 <br />Re ' quished Date: Time: <br />fob 1O� <br />I <br />Received By: Date: Time: <br />vU <br />Received By: Date: Time: <br />1�� <br />Corporate Offices & Laboratory mimmwi <br />853 Corporation Street <br />Office & Laboratory <br />2500 Stagecoach Road <br />Office & Laboratory <br />563 E. Lando Avenue <br />Office & Laboratory <br />3442 Empresa Drive, Suite D <br />Santa Paula, CA 93060 <br />Stockton, CA 95215 <br />Chico, CA 95926 <br />San Luis Obispo, CA 93401 <br />TEL: (805)392-2000 <br />TEL: (209)942-0182 <br />TEL: (530)343-5818 <br />TEL: (805)783-2940 <br />Env FAX: (805)525-41721 Ag FAX: (805)392-2063 <br />CA ELAP Certification No. 1573 <br />FAX: (209)942-0423 <br />CA ELAP Certification No. 1563 <br />FAX: (530)343-3807 <br />CA ELAP Certification No. 2670 <br />FAX: (805)783-2912 <br />CA ELAP Certification No. 2776 <br />Office & Laboratory <br />9415 W. Goshen Avenue <br />Visalia, CA 93291 <br />TEL: (559)7349473 <br />FAX: (559)734-8435 <br />CA ELAP Certification No. 2810 <br />