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- 3 <br />0 <br />CD <br />170 <br />2.1 <br />2 <br />o, <br />F,- ::, I g" I) Number: npler(s) i6i/e. :npling Fee: Pickup Fee: rupositor Setup Date: / Time: / mt: Fruit Growers Laboratory, Inc. iress: FGL Environmental, Inc. 853 Corporation St. Santa Paula, CA 93060-3005 me: Fax: ntact Person: ,ject Name: /76-0i79 _ (3-18039) -chase Order Number: ote Number: ,....- <br />CS) Location Description ...,.. <br />"••••,- .....1 Date Sampled Clk a— <br />a. <br />c:t ,-< <br />%0 <br />_ t 2 —,4 <br />—...1 0 Re uished / Date: Time: 5747;7 17e6 Method of Sampling: Composite(C) Grab(G) 35866:08/07/2017 Type of Sample **SEE REVERSE SIDE** <br />Potable(P) Non-Potable(NP) Ag Water(AgW) <br />Bacti Type: Other(0) System(SYS) Source(SR) Waste(W) <br />Bacti Reason: Routine(ROUT) Repeat(RPT) Replace(RPL) <br />Other(0) Special(SPL) <br />— <br />Sub Contracted-Oryzahn <br />1000m1(AGJ) TEST DESCRIPTION - See Reverse side for Container, Preservative and Sampling information Received By: Date: Time: Relinquished Date: Time: Received By: Date: Time: (Cf3tfr It'. SS Relinquished Date: Time: 0 !soliaLID IeDiVietIV INN=