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www.fglinc.com <br />CHAIN OF CUSTODY <br />AND ANALYSIS REQUEST DOCUMENT <br />Client: trc oo'- C"a 6"'N -o^ vK <br />Lab <br />Ntunber: <br />Offico & Laboratory <br />Office & Laboratory <br />853 Corporation Street <br />2500 Stagecoach Road <br />TEST DESCRIPTION AND ANALYSES REQUESTED. <br />3442 Empresa Drive, Suite D <br />Customer Number: <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 />Address: "-x W . Oa,(e 34 <br />LovL C,,N PI.Y2.44 5 <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 />Phone: L Vo`i 3tp°I ` 031 T Fax: <br />EmailAddress: ajo lr' a leyy>,odii• c cv� <br />Contact Person: Abby) P&C.C.o <br />Project Name: I" ytr, oA -w <br />Purchase Order Number: <br />Quote Number: <br />U <br />8 <br />$ <br />_ <br />_ <br />8 <br />s <br />F <br />>r <br />fie <br />rs <br />d <br />v Z <br />Rush Analysis: ❑ 5 Day ❑ 4 Day ❑ 3 Day ❑ 2 Day ❑ 24 hour <br />Rush pre -approval by lab (inuals): <br />Dectronie Data Transfer: No Slate Ctient Other: <br />Sampler(s): <br />p� <br />Sampling Fee: Pickup Fee: <br />Compositor Setup Date: Time: <br />Samp Location Description Date Time <br />Num Sampled Sampled <br />ernarks <br />Refineiijusbed <br />Date: <br />►i-t�1-z1 <br />Time: <br />r :7-0 <br />Relinquished <br />/��� <br />Date: <br />�2/KtI2r <br />Time: <br />ISZS <br />Relinquished <br />� 1 �5 <br />Date: Time: <br />ZI I U �S <br />Received By: <br />Date: <br />Time: <br />R ed Date: <br />Time: <br />Received By: <br />Date: Time: <br />Corporato Offloos & Laboratory <br />Offloo & Laboratory <br />ONioo & Laboratory <br />Offico & 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 />