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Special <br />CHAIN OF CUSTODY <br />www.fglinc.com <br />,Field Copy (3 of 3) ENVIRONMENTAL AGRICULTURAL <br /> <br />Analytical Chemists <br /> <br />1 11111111111111. 1111 I. P II 35731.02/06/2017 TEST DESCRIPTION - See Reverse side fOr Container. Preservative and Sampling information <br />Client: <br />Address: <br />Phone: <br />Contact <br />Project <br />Purchase <br />Quote <br />San Joaquin County EHD <br />San Joaquin Co. Environmental Health Dep <br />Water Quality Division <br />Attn: Rodney Estrada <br />1868 East Hazelton Ave. <br />Stockton, CA 95205 <br />(209)468-0331 Fax: <br /> <br />Person: Rodney Estrada <br />-', ',-; '` -. Name: - r. ..› .,..,' <br />Order Number: <br /> <br />Number: ST 20160309-01 Method of Sampling: Composite(C) Grab(G) to Type of Sample **SEE REVERSE SIDE** Potable(P) Non-Potable(NP) Ag Water(AgW) Time Sampled Bacti Type: Other(0) System(SYS) Source(SR) Waste(W) Bacti Reason: Routine(ROUT) Repeat(RPT) Replace(RPL) Other(0) Special(SPL) i' <br />0 <br />a. u XI 9 ...,? <br />g <br />Sampler(s) <br />Sampling <br />Compositor <br />Fee: Pickup Fee: <br />Setup Date: / Time: / <br />Lab Number: STK 3-17919 <br />Num <br />Samp Date Location Description Sampled <br />(1 Travel Blank 4 <br />I G DW 4 <br />Remark, : Relinquished Date: Time: Relinquished Date: Time: Relinquished Date: Time: <br />Received By: Date: Time: Received By: Date: Time: Received By: Date: "I line: <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, Suite 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