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12,0..;vm.s.Prieitc-v t-41-7-1 G 1 P Bact: System (Sys) Source (SRC) Sod (S) Sludge (SLG) sad (s Potable (P) Non-Potable (NP) Received By: t Date: Time: <br />t Pit \14 I tfiC <br />Field Office <br />Visalia, California <br />TEL: 559(734-9473. <br />Mobile: 559/737-2399 <br />FAX: 559(734-8435 <br />Office & Laboratory <br />563 E. Undo Avenue <br />Chico, CA 95926 <br />TEL: 530/343-5818 <br />FAX: 530/343-3807 <br />CA ELAP Certification No. 2670 <br />Office & Laboratory <br />2500 Stagecoach Road <br />Stockton, CA 95215 <br />TEL: 209/942-0182 <br />FAX: 209/942-0423 <br />CA ELAP Certification No. 1563 <br />Corporate Offices & Laboratory <br />853 Corporation Street <br />Santa Paula, CA 93080 <br />TEL: 805/392-2000 <br />FAX: 805/525-4172 <br />CA NELAP Certification No. 01110CA <br />Lab Number: <br />2131 341g <br />TEST DESCRIPTION AND ANALYSES REQUESTED <br />Live Oak GeoEnvironmental <br />3016608 <br />407 W. Oak St. <br />Lodi, CA 96240 <br />Phone: (209) 369-0375 Fax <br />Email Address: abbyglogelodi.com <br />Contact Person: Abby Racco <br />0-0 <br />Project Name: 6+07 t4.). S4 . 1.1-; _ . <br />Purchase Order Number <br />Quote Number <br />Sampler(s): <br />P0114) <br />Sampling Fee: r Pieku • : <br />Compositor Setup Date: Time: <br />I Date1 Time <br />Sampled Sampled <br />RecerX <br />pate: Time: Relinquished Date: Time: <br />Vo2 ?/a:91 net) rabl(1/1. I (4K <br />Received By: / Date:, Time: <br />WZI 4'2 /X91 (PO <br />Date: Time: <br />1-4`)- LI 0%0-1 <br />Samp I <br />Num <br />Location Description Number of Containers Type of Containers: Glass (G) Plastic (P) VOA (V) Metal Tube (MT) Method of Sampling: Composite (C) Grab (G) Client: <br />Customer Number <br />Address: <br />Remarks <br />-1 &t en izJet, <br />ENVIRONMENTAL <br />CHAIN OF CUSTOD_ <br />AND ANALYSIS REQUEST DOCUMENT