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IrL7-�,, <br />auahliCnl Ulclws(s <br />CIM OF CUSTODY <br />Special www.fgUnc.com <br />Laboratory Copy (f of 3) <br />a_ <br />Corporate Offices & Laboratory <br />853 Corporation Street <br />1.5730: <br />06/2017 <br />TESL' DESCRIPTION See Reverse side for Cuntait Prcsenativt <br />and Sampling <br />inl'ormation <br />pTlient: Sdn Joaquin County EHD <br />Fax: (209) 942-0423 <br />Address: San Joaquin Co. Environmental Health Dep <br />�e <br />"! <br />4; <br />Water Quality Division <br />s <br />a <br />r <br />w <br />r' Atm: Rodney Estrada <br />1868 fast Hazelton Ave. <br />Stockton, CA 95205 <br />j <br />3 <br />=" <br />a <br />Phone: (209)468-0331 Fax: <br />w <br />3r, <br />N <br />x <br />Contact Person: Rodney Estrada <br />1* <br />Q <br />2 <br />Project Name: 1Op2g' GGf�e(coroIIS�S�weKlvy� <br />w <br />h <br />3 <br />Cd <br />Purchase Order Number: <br />a <br />w <br />Quote Number: ST 20160309-01 <br />U <br />N <br />< <br />`✓ <br />E <br />y <br />0 <br />a <br />N F- <br />0 <br />Sampler(s) CFtne) <br />•S(,s,.sjYCK;,i7j <br />„o <br />o <br />o <br />°N <br />ao <br />S m <br />Sampling Fee: Pickup Fee: <br />e <br />Compositor Setup Date: / / Time: _/_ <br />--- <br />a <br />EE <br />"n <br />0 <br />S <br />•5 <br />o <br />E <br />o <br />u <br />z <br />a <br />9 <br />O <br />F <br />x <br />CH <br />a� <br />�' Z <br />c^ <br />a <br />,= <br />O <br />CZ <br />a— <br />C— H II <br />Eamp <br />o <br />•9 <br />E <br />0 <br />v <br />u <br />Lab Number: STK!MoX 3-17919 <br />Location Description <br />Date <br />Time <br />Sampled <br />Sampled <br />° <br />- <br />`'10Num <br />I <br />ITed <br />)j/j,5 <br />0%00 <br />G <br />DW <br />t <br />1.1.1 51. <br />/S <br />09 <br />Remarks: <br />Rel' d Date: Time: <br />Relinq ' Date: Time: Relinquished <br />Date: Time: <br />suy�� <br />I�/��:► <br />�5 2� i �v�I <br />OM <br />Receive Date: Time: <br />Recety B Date: Time: Received <br />By: Date: Time: <br />09 <br />Corporate Offices & Laboratory <br />853 Corporation Street <br />Office & Laboratory <br />2500 Stagecoach Road <br />Santa Paula, CA 93060 <br />Stockton, CA 95215 <br />Phone: (805) 392-2000 <br />Phone: (209) 942-0182 <br />Env Fax: (805) 525-4172 / Ag Fax: (805) 392-2063 <br />Fax: (209) 942-0423 <br />Office & Laboratory <br />563 E. Undo <br />Chico, CA 95926 <br />Phone: (530) 343-5818 <br />Fax: (530) 343-3807 <br />Office b Laboratory <br />3442 Empresa Drive, Suite D <br />San Luis Obispo, CA 93401 <br />Phone: (805) 783-2940 <br />Fax: (805) 783-2912 <br />Office & Laboratory <br />9415 W. Goshen Avenue <br />Visalia, CA 93291 <br />Phone: (559) 7349473 <br />Fax: (559) 7348435 <br />