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Special <br />CHAIN OF CUSTODY <br />www.fgUnc.com <br />,Laboratory Copy (1 of 3) <br />1111011111111 <br />PCF-mms... <br />35730:02/0612017 <br />TEST DESCRIP r:ON - See Reve(se side for Container, Preservative and Sampling <br />information <br />Joaquin County EHD <br />853 Corporation Street <br />2500 Stagecoach Road <br />563 E. Lindo <br />3442 Empresa Drive, Sui e D <br />9415 W. Goshen Avenue <br />Santa Paula, CA 93060 <br />__Stec kton, CA 95215 <br />Chico, CA 95926— <br />San Luis Obispo, CA 93401vtsalia,-CAE291 <br />g <br />Phone: (805) 392-2000 <br />PhDrte (209) 942-0182 <br />— -Phone: (530) 343-5818 <br />Phone: (805) 783-2940 <br />Phone: (559) 7349473 <br />Env Fax: (805) 525A1721Ag 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 />Attn: Rodney Estrada <br />1868 East Hazelton Ave. <br />Stockton, CA 95205 <br />3 <br />0 <br />(Phone: (209)468.0331 Fax: <br />x <br />Contact Person: Rodney EstradaCn <br />A <br />Q <br />� <br />Project Name: t r LJI V V,1V,b Lc <br />, <br />a <br />r i <br />v <br />3 <br />Purchase Order Number: <br />V3 <br />°� <br />Quote Number: ST 20160309-01 <br />y <br />Q <br />P, <br />0^ <br />a <br />Sampler(s) <br />h <br />N <br />a <br />0 <br />x <br />Sampling Fee: Pickup Fee: <br />;o <br />5 <br />a <br />O <br />v <br />•`3 ai <br />'o <br />Q O <br />p' r4 <br />`O <br />w <br />n <br />Compositor Setup Date: / /— Time: —/— <br />-- <br />E <br />v� <br />o <br />$ <br />S <br />a <br />E <br />w <br />o <br />�' <br />, <br />z <br />V <br />= <br />o <br />O <br />t- <br />u <br />a <br />�v: <br />a <br />U.S <br />U •5 <br />°' Z <br />0x <br />U <br />O <br />ii <br />a o <br />m ,,, <br />u y <br />x <br />a <br />a <br />a <br />,'LabNumber: STK 3-17919 <br />i. <br />amp <br />�)\um <br />Date <br />Location Description <br />Time <br />Sampled <br />Sampled <br />E-• <br />n, <br />oa <br />m O <br />N <br />U —• <br />to �+ <br />w�=/: <br />w <br />w <br />G <br />DW <br />1 <br />1,1,1 <br />7.61i <br />,0 <br />1' <br />1 7 <br />Remarks: <br />Relinquished Date: Time: <br />Relinqut d D tc: 'rime: <br />RpliAguishDate: Time: <br />A*0�n 4_f0_Zf j <br />iv -D <br />(f� <br />, j <br />Received By: Date: TimC. <br />Received By: Da Time: <br />cei d B Date: TirAa: <br />a <br />�a i��� <br />f� 2 I <br />11 ,D5 <br />_ <br />Corporate Offices & Laboratory <br />Office & Laboratory <br />Office & Laboratory <br />Offlcg & Laboratod <br />ce & Laboratory <br />853 Corporation Street <br />2500 Stagecoach Road <br />563 E. Lindo <br />3442 Empresa Drive, Sui e D <br />9415 W. Goshen Avenue <br />Santa Paula, CA 93060 <br />__Stec kton, CA 95215 <br />Chico, CA 95926— <br />San Luis Obispo, CA 93401vtsalia,-CAE291 <br />Phone: (805) 392-2000 <br />PhDrte (209) 942-0182 <br />— -Phone: (530) 343-5818 <br />Phone: (805) 783-2940 <br />Phone: (559) 7349473 <br />Env Fax: (805) 525A1721Ag 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 />r, <br />