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I 11111111 11111 1111 I 111 II II I 111111 11111 11111 1 111 1 11111 1111 1111 <br />Client: San Joaquin County EHD <br />Address: San Joaquin Co. Environmental Health Dep <br />Water Quality Division <br />Attn: Rodney Estrada <br />1868 East Hazelton Ave. <br />Stockton, CA 95205 <br />Phone: (209)468-0331 Fax: <br />Contact Person: Rodney Estrada <br />Project Name: <br />Purchase Order Number: <br />Quote Number: ST 20160309-01 <br />Sampler(s) <br />Sampling Fee: Pickup Fee: <br />Compositor Setup Date: / / Time: / <br />Lab Number: STK <br />3-17919 <br />Time <br />Sampled <br />35731:02/06/2017 TEST DESCRIPTION - See Reverse side for Container. Preservative and Sampling information <br />Samp <br />Num Location Description Date <br />Sampled SEE REVERSE SIDE** a) <br />(I) <br />0 <br />a.) Q. Non-Potable(NP) Ag Water(AgW) Bacti Type: Other(0) System(SYS) Source(SR) Waste(W) Relinquished <br />Time: Received By: <br />Date: Time: <br />Date: Time: <br />Relinquished <br />Received By: <br />Date: Time: <br />Date: Time: <br />0 Travel Blank ci LBW <br />1 ci DW 4 <br />Remarks: Relinquished <br />Received By: Date: <br />Date: Time: <br />Special <br />CHAIN OF CUSTODY <br />www.fglinc.com <br />Field Copy (3 of 3) <br /> <br />Corporate Offices & Laboratory Office & Laboratory Office & Laboratory Office & Laboratory Office & Laboratory <br />853 Corporation Street 2500 Stagecoach Road 563 E. Undo 3442 Empresa Drive, Suite D 9415W. Goshen Avenue <br />Santa Paula, CA 93060 Stockton, CA 95215 Chico, CA 95926 San Luis Obispo, CA 93401 Visalia, CA 93291 <br />Phone: (805) 392-2000 Phone: (209) 942-0182 Phone: (530) 343-5818 Phone: (805) 783-2940 Phone: (559) 734-9473 <br />Env Fax: (805) 525-4172 / Ag Fax: (805) 392-2063 Fax: (209) 942-0423 Fax: (530) 343-3807 Fax: (805) 783-2912 Fax: (559) 734-8435