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ENVIRONMENTAL = AGRICULTURAL <br />Analytical Chemists <br />CHAIN OF CUSTODY <br />Special www.fgUnc.com <br />Customer Copy (2 of 3) <br />Corporate Offices & Laboratory Office & Laboratory <br />853 Corporation Street 2500 Stagecoach Road <br />Santa Paula, CA 93060 Stockton, CA 95215 <br />Phone: (805) 392-2000 Phone: (209) 942-0182 <br />Env Fax: (805) 525-4172 / Ag Fax: (805) 392-2063 Fax: (209) 942-0423 <br />Office & Laboratory <br />563 E. Lindo <br />Chico, CA 95926 <br />Phone: (530) 343-5818 <br />Fax: (530) 343-3807 <br />Office & 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) 734-9473 <br />Fax: (559) 734-8435 <br />35731:08/02/2021 <br />TEST DESCRIPTION <br />- See Reverse <br />siae <br />1,J Container, <br />Preservative <br />and <br />Sampling <br />information <br />Client: San Joaquin County EHD <br />Address: San Joaquin Co. Environmental Health Dep <br />Water Quality Division <br />Attn: Michael Kith <br />3 <br />a <br />1868 East Hazelton Ave. <br />Stockton, CA 95205 <br />3 <br />a <br />Phone: (209)468-3444 Fax: <br />� <br />A <br />3 <br />Contact Person: Michael Kith \, <br />\\ \ <br />Cc <br />Project Name: — <br />� <br />&n <br />Purchase Order Number: <br />3 <br />N <br />0 <br />T <br />Quote Number: <br />6w <br />o <br />w <br />x <br />rn <br />z <br />a <br />A <br />Sampler(s) ` -., � <br />Sampling Fee: Pickup Fee: <br />c <br />Q <br />Compositor Setup Date: Time: <br />� <br />z <br />p <br />a <br />p <br />w <br />Lab Number: STK 3-17919 <br />0 <br />-5 <br />ii <br />a <br />> <br />0— <br />o <br />amp <br />Date <br />Time <br />Num <br />Location Description <br />Sampled <br />Sampled <br />o <br />S <br />I <br />G <br />DW <br />Sub -3 <br />Remarks: <br />Relinquished Dain: Time: <br />Relinquished Date: Time: <br />Relinquished Uate: lime: <br />Received By: Date: Time: <br />Received By: Date: Time: <br />Received By: Dar: l imc: <br />Corporate Offices & Laboratory Office & Laboratory <br />853 Corporation Street 2500 Stagecoach Road <br />Santa Paula, CA 93060 Stockton, CA 95215 <br />Phone: (805) 392-2000 Phone: (209) 942-0182 <br />Env Fax: (805) 525-4172 / Ag Fax: (805) 392-2063 Fax: (209) 942-0423 <br />Office & Laboratory <br />563 E. Lindo <br />Chico, CA 95926 <br />Phone: (530) 343-5818 <br />Fax: (530) 343-3807 <br />Office & 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) 734-9473 <br />Fax: (559) 734-8435 <br />