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<br />CHAIN OF CUSTODY <br />www.fglinc.com <br />Laboratory Copy (1 of 3) <br /> IF-GL <br />LNVIRONNIMTAL ACIRICULTLRAL <br /> <br />Special <br /> <br />Clicissi5ts <br /> <br />1111111111111111MIL I 1111111111111111111111. 35866.08/07/2017 TEST DESCRIPTION - See Reverse side for Container, Preservative and Sampling information <br />Client: Kimberly Martin <br />Address: 2112 S. Main St. <br />Manteca, CA 95337 <br />Phone: (209)482-2099 Fax: <br />Contact Person: Kimberly Martin <br />Project Name: 2096 S. Main St. <br />Purchase Order Number: <br />Quote Number: Method of Sampling: Composite(C) Grab(G) Type of Sample **SEE REVERSE SIDE** Potable(P) Non-Potable(NP) Ag Water(AgW) Bacti Type: Other(0) System(SYS) Source(SR) Waste(W) Time Bacti Reason: Routine(ROUT) Repeat(RPT) Replace(RPL) Other(0) Special(SPL) I EPA 524.2 - 1,2 DCP 40m1(V0A)-HCI 8 <br />t" <br />1 <br />.9 EPA 508 - Pesticides 1000m1(AGT) Sub Contracted-Oryzalin 1000m1(AGJ) SRL 524M-TCP 40m1(VOA) Sampler(s) <br />Sampling <br />Compositor <br />Vkit( -f,___ EVC01^111,‘ <br />Fee: Pickup Fee: <br />Setup Date: Time: / _/_/__ <br />Lab Number: STK I ./ 5-0 O 75 3-18039 <br />Num <br />Samp Date Location Description Sampled Sampled <br />0 Travel Blank E.VZe//2()P,C G LBW 2 <br />1 Domestic Well 1V34 14_13 I 090.5—G DW 2 I Sub-1 Sub-1 2 <br />I <br />Remarks: <br /> <br />Jo $R, tmple_ -i-ctee_ tiue,(1hti,j <br /> <br />use d wes-fr 1+ B c (aes-t- -f- 0 <br /> <br />Rei6f • : / , D te: Time: <br /> <br />//1 / ( 3-2X-) <br />in *shed ?ate: Time: <br /> <br />3/n117 170-6 <br />Re ' • quished Date: Time: <br />... - d By: te: Time: Received By: / Date: Time:( Re eiv • B Date: Time: <br />i 1/2//7 //. gcl <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, ulte 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