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• CI WN OF CUSTODY <br />Special www.fgUnc.com <br />Customer Copy (2 of 3) <br />LIWIIIIIIIIIIIIIIIIIW�1Wlllh <br />35730:02/06/2017 <br />TEST DESCRIPTION See Reverse side for Container, Preservative and Sampling <br />information i <br />Client: San Joaquin County EHD <br />853 Corporation Street <br />2500 Stagecoach Road <br />563 E. Lindo <br />3442 Empresa Drive, Suite D <br />9415 W. Goshen Avenue <br />Santa Paula, CA 93060 <br />Stockton, CA 95215 <br />Chico, CA 95926 <br />San Luis Obispo, CA 93401 <br />Visalia, CA 93291 <br />Phone: (805) 392-2000 <br />Phone: (209) 942-0182 <br />Phone: (530) 343-5818 <br />Phone: (805) 783-2940 <br />Phone: (559) 734-9473 <br />Env Fax: (805) 525-4172 /Ag Fax: (805) 392-2063 <br />Address: San Joaquin Co. Environmental Health Dep <br />Fax: (530) 343-3807 <br />Fax: (805) 783-2912 <br />Fax: (559) 734-8435 <br />Water Quality Division <br />3 <br />a <br />Attn: Rodney Estrada <br />o; <br />1868 East Hazelton Ave. <br />Stockton, CA 95205 <br />3 <br />Phone: (209)468-0331 Fax: <br />x <br />Contact Person: Rodney Estrada <br />�{ <br />M <br />Project Name: <br />Purchase Order Number:Ln <br />a <br />ua <br />Quote Number: ST 20160309-01 <br />o04 <br />aE <br />P; <br />;; <br />000 <br />AW <br />Sampler(s) <br />o <br />W <br />z <br />O <br />.a <br />U <br />�? <br />a <br />a <br />O <br />`o <br />x <br />Sampling Fee: Pickup Fee: <br />°" <br />r'" � <br />p F" <br />Compositor Setup Date: _/ /_ Time: _/_ <br />a <br />o <br />z <br />J <br />O <br />n <br />04 <br />0 to <br />o z <br />a z <br />w4- �• <br />A <br />F <br />Lab Number: STK i 3-17919 <br />Cn <br />n <br />a <br />o <br />'U <br />a <br />a <br />a <br />Samp <br />Date <br />Time <br />Numled <br />Location Description <br />Sam P led <br />Sam P <br />" <br />' <br />F• <br />° <br />w <br />`" <br />W <br />PG O <br />° <br />V C <br />1 <br />G <br />DW <br />Remarks: <br />Relinquished Date: Time: <br />Relinquished Date: Time: <br />Relinquished Date: Time: <br />Received By: Date: Time: <br />Received By: Date: Time: <br />Received By: Date: ['title: <br />Corporate Offices & Laboratory <br />Office & Laboratory <br />Office & Laboratory <br />Office & Laboratory <br />Office & Laboratory <br />853 Corporation Street <br />2500 Stagecoach Road <br />563 E. Lindo <br />3442 Empresa Drive, Suite D <br />9415 W. Goshen Avenue <br />Santa Paula, CA 93060 <br />Stockton, CA 95215 <br />Chico, CA 95926 <br />San Luis Obispo, CA 93401 <br />Visalia, CA 93291 <br />Phone: (805) 392-2000 <br />Phone: (209) 942-0182 <br />Phone: (530) 343-5818 <br />Phone: (805) 783-2940 <br />Phone: (559) 734-9473 <br />Env Fax: (805) 525-4172 /Ag Fax: (805) 392-2063 <br />Fax: (209) 942-0423 <br />Fax: (530) 343-3807 <br />Fax: (805) 783-2912 <br />Fax: (559) 734-8435 <br />