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CHAIN OF CUSTODY <br /> www.fglinc.com AND ANALYSIS REQUEST DOCUMENT <br /> alNn: Beattie Grocery Lab Number: TEST DESCRIPTION AND ANALYSES REQUESTED <br /> Castamer Number: 3018813 i3 83k <br /> Address: 255 E.French Came Road <br /> French Camp.CA. 95231 <br /> Phone: (2091774-6747 Fax: ; 3 <br /> m <br /> cv <br /> Fina9Ad&m: ck.g2612(d)..omail.com <br /> Contact Person: Taiinder Sinqh Sandhuf g <br /> Prgxi Name: STOP&SHOP MART,INC. V' <br /> Purchase Order Number: g p o 4r <br /> Quote Number: UC ?£ = Q g3 <br /> u 8 € o E 3 <br /> Rush Malysa: 5 Day 4 Day 3 Day 2 Day 24 hour E <br /> Rush pre-approval by gab(alnals): !• <br /> Ehxlronic Dara Trasrsfcr: ❑No E1 Slaze Client lhher: <br /> Samplens): <br /> Corey E <br /> q 9 Wq� 33 <br /> Sampling Fee: Pickup Fee <br /> Compositor Setup Daze: Tune: <br /> Sump Location Description Date T Time _ p, rq m q v $ 5_ r m <br /> Num Sampled Sanpkd z z a w <br /> 1 Wellhead O6/14/21 0840 G 3 P P DW SRC O 6 X X X X <br /> Refineries Wquih Date: Tune: R quishM Daze: Thee:T Refmquohed Date: Tmie: <br /> Sampling Fee$75.00 <br /> OT100$33.00 <br /> Nitrate$30.00 BK Date: Tune: Recf ved By. Date: Tune Received By. Date Thee <br /> © : <br /> Nitrite$30.00 Total$168.00 Paid by Card l X310 Y7�°R /��' / <br /> .XJeLY.�'� <br /> a <br /> Corporato offices 6 Laboratory Olffoo as Loboretory Office&Laboratory Office as Laboratory Office d Laboratory <br /> 653 Corporation Sbeet 2500 Stagacoech Road 563 E.Undo Avenue 3442 Empmaa Odve,Sues D 0415 W.Goshen Avenue <br /> Santa Paula,CA 93060 Stotldon.CA 95215 Chloe.CA 95826 San Luis Obispo,CA 03401 Vlasb9,CA 03201 <br /> TEL:(806)392-2000 TEL:(208)942-0182 TEL:(530)343-5818 TEL:(905)783-2940 TEL:(559)7349473 <br /> Env FAX;(805)525-41721 Ag FAX:(W5)392-2063 FAX:(209)9412-0423 FAX:(530)343-3807 FAX:(1105)783-2912 FAX:(559)734-8435 <br /> CA ELAP GonflcaWn No.1573 CA ELAP Codification No.1563 CA ELAP Cedl9ce0on No.2670 CA ELAP CeNticadon No.2775 CA ELAP Ceniflcaton No.2810 <br />