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EN VIIZONy 1t.:N'IALgQWAGRICU11111W, <br />Analylical 0willisls 7 <br />www.fglinc.com <br />CHAIN OF CUSTODY <br />AND ANALYSIS REQUEST DOCUMENT <br />Client: LIVE is aK (!rtDiJ3'*J'A0r- t tttr p'T-?RL <br />Offleo & Laboratory <br />Lab Number: <br />Offloo & Laboratory <br />Office & Laboratory <br />853 Corporation Street <br />2500 Stagecoach Road <br />563 E. Undo Avenue <br />TEST DESCRIPTION AND ANALYSES REQUESTED <br />9415 W. Goshen Avenue <br />Customer Number: 30 Into aE- <br />Stockton, CA 95215 <br />Chico, CA 95926 <br />San Luis Obispo, CA 93401 <br />Visalia, CA 93291 <br />TEL: (805)392-2000 <br />TEL: (209)942-0182 <br />TEL: (530)343-5818 <br />TEL: (805)783-2940 <br />TEL: (559)734-9473 <br />Env FAX: (805)525-4172 1 Ag FAX: (805)392-2063 <br />FAX: (209)942-0423 <br />FAX: (530)343-3807 <br />Address: .401 w• v PCK ST <br />FAX: (559)734-8435 <br />CA ELAP Certification No.1573 <br />CA ELAP Certification No. 1563 <br />CA ELAP Certification No. 2670 <br />CA ELAP Certification No. 2775 <br />CA ELAP Certification No. 2810 <br />L.D,g � c^ q T 2_r4 0 <br />Phone:(74o`1)34ri-C3-)S Fax: <br />Email Address: "170(22 ( c arLt v <br />Contact Person: "3y (L -ACCO <br />Project Name: jzA i n1 vjA1-V2- <br />Purchase Order NuniNT <br />Quote Number: <br />(7 <br />a <br />$ <br />$ <br />Q <br />OC <br />_ <br />� <br />3 <br />O <br />� <br />1 <br />s <br />yL <br />••• <br />pi2 <br />6 <br />k <br />a <br />_ <br />� <br />E <br />V <br />19 <br />TE <br />t <br />Rush Analysis: ❑ S Day ❑ 4 Day F13 Day F]2 Day ❑ 24 hour <br />Rush pre -approval by lab (initals): <br />Electronic Data Transfer: No State Client Other: <br />Sampler(s): <br />pr 8t3 y 2+°r c C o <br />Sampling Fee: Pickup Fee: <br />Compositor Setup Date: Timc: <br />Samp Location Description Date TEtne� <br />Num Sampled Sampled <br />1 R-�t,•,,,rrt�Ew,�fo1 o Io -Zs -al B.So <br />G <br />t <br />P <br />Lob 1 <br />Remarks <br />Relin <br />fished <br />Date: <br />Time: <br />Re' quished <br />Date: Time: <br />Relutquished Date: <br />Time: <br />21 <br />11: <br />Zo <br />2 13 - <br />,Recceived By: <br />if -A � <br />Date: Time: <br />10�7�/21 13, 2p <br />am <br />e: Time: <br />1o1lu/"Vf /A17 <br />Received By e: <br />I a/f <br />Time <br />\j <br />Corporate Officos & Laboratory <br />Offleo & Laboratory <br />Offloo & Laboratory <br />Offloo & Laboratory <br />Office & Laboratory <br />853 Corporation Street <br />2500 Stagecoach Road <br />563 E. Undo Avenue <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 />TEL: (805)392-2000 <br />TEL: (209)942-0182 <br />TEL: (530)343-5818 <br />TEL: (805)783-2940 <br />TEL: (559)734-9473 <br />Env FAX: (805)525-4172 1 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 />CA ELAP Certification No.1573 <br />CA ELAP Certification No. 1563 <br />CA ELAP Certification No. 2670 <br />CA ELAP Certification No. 2775 <br />CA ELAP Certification No. 2810 <br />