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Iil ENVIRONMENTAL <br />-Wv <br />CHAIN OF CUSTODY <br />AND ANALYSIS REQUEST DOCUMENT <br />Corporate Offices d. Laboratory <br />853 Corporation Street <br />Santa Paula, CA 93060 <br />TEL: 8051392.2000 <br />FAX: 8051525-4172 <br />CA NELAP Certificalion No. 01110CA <br />A <br />N <br />Office & Laboratory <br />2500 Stagecoach Road <br />Stockton, CA 95215 <br />TEL: 209/942-0182 <br />FAX: 209/942-0423 <br />CA ELAP Certification No. 1563 <br />Office 6 Laboratory <br />563 E. Lindo Avenue <br />Chico, CA 95926 <br />TEL: 5301343-5818 <br />FAX: 5301343-3807 <br />CA ELAP Certification No. 2670 <br />Field Office <br />Visalia, California <br />TEL: 559!734-9473 <br />Mobile: 5591737-2399 <br />FAX: 559/734-8435 <br />Remarks <br />Number: <br />clinq 'shed Da7: Time: <br />Relinquished Date: Time: <br />TEST DESCRIPTION AND ANALYSES REQUESTED <br />.m <br />d.12-cj/22 13: <br />I�Lab <br />I <br />o <br />—A Rush <br />By: / Date: Time; <br />/ <br />Rec ' ed By: /yam//p/a�te: Time: <br />08 <br />? i <br />t <br />Compositor Setup Date: Time: <br />$ <br />� - � <br />Client: Live Oak GeoEnvironmental <br />� <br />�, '� °rh i � <br />s <br />•� .. � <br />Samp <br />Location Description <br />I <br />Customer Number: 3016608 <br />Time y, <br />I <br />.� <br />g <br />Address: 407 W. Oak St. <br />u <br />Num <br />Sampled <br />Sampled <br />2 <br />Lodi, CA 96240 <br />1 <br />I I <br />i <br />Phone: Fax: <br />(209) 369-0375 <br />G <br />2 G <br />i <br />Email Address: abby@Iogelodi.eom <br />1 Domestic Well <br />— <br />�s'y>`i� 11:00 <br />G . <br />4 1 P/G <br />P DW <br />Contact Person: Abby Racco <br />s <br />g <br />; <br />Project Name: Nunez, 12622 E. Harney Ln, Lodi <br />n <br />` <br />Purchase Order Number. <br />3 <br />Quote Number. <br />> <br />0€ <br />i • s - <br />l t <br />Sampkt(s>: <br />4cue <br />z <br />Corporate Offices d. Laboratory <br />853 Corporation Street <br />Santa Paula, CA 93060 <br />TEL: 8051392.2000 <br />FAX: 8051525-4172 <br />CA NELAP Certificalion No. 01110CA <br />A <br />N <br />Office & Laboratory <br />2500 Stagecoach Road <br />Stockton, CA 95215 <br />TEL: 209/942-0182 <br />FAX: 209/942-0423 <br />CA ELAP Certification No. 1563 <br />Office 6 Laboratory <br />563 E. Lindo Avenue <br />Chico, CA 95926 <br />TEL: 5301343-5818 <br />FAX: 5301343-3807 <br />CA ELAP Certification No. 2670 <br />Field Office <br />Visalia, California <br />TEL: 559!734-9473 <br />Mobile: 5591737-2399 <br />FAX: 559/734-8435 <br />Remarks <br />Relinquished Date: Time: <br />clinq 'shed Da7: Time: <br />Relinquished Date: Time: <br />.m <br />d.12-cj/22 13: <br />Sampling Fee: _ Pickup Fce: <br />o <br />—A Rush <br />By: / Date: Time; <br />/ <br />Rec ' ed By: /yam//p/a�te: Time: <br />08 <br />? i <br />t <br />Compositor Setup Date: Time: <br />$ <br />� - � <br />is � <br />� <br />�, '� °rh i � <br />s <br />•� .. � <br />Samp <br />Location Description <br />I <br />Date <br />I <br />Time y, <br />I <br />.� <br />g <br />'R <br />u <br />Num <br />Sampled <br />Sampled <br />2 <br />1 <br />I I <br />0 Travel Blank2i <br />I1�ol� <br />� <br />G <br />2 G <br />_ . <br />X <br />1 Domestic Well <br />— <br />�s'y>`i� 11:00 <br />G . <br />4 1 P/G <br />P DW <br />SRC O <br />X . X <br />i • s - <br />Corporate Offices d. Laboratory <br />853 Corporation Street <br />Santa Paula, CA 93060 <br />TEL: 8051392.2000 <br />FAX: 8051525-4172 <br />CA NELAP Certificalion No. 01110CA <br />A <br />N <br />Office & Laboratory <br />2500 Stagecoach Road <br />Stockton, CA 95215 <br />TEL: 209/942-0182 <br />FAX: 209/942-0423 <br />CA ELAP Certification No. 1563 <br />Office 6 Laboratory <br />563 E. Lindo Avenue <br />Chico, CA 95926 <br />TEL: 5301343-5818 <br />FAX: 5301343-3807 <br />CA ELAP Certification No. 2670 <br />Field Office <br />Visalia, California <br />TEL: 559!734-9473 <br />Mobile: 5591737-2399 <br />FAX: 559/734-8435 <br />Remarks <br />Relinquished Date: Time: <br />clinq 'shed Da7: Time: <br />Relinquished Date: Time: <br />d.12-cj/22 13: <br />/ <br />/ 3a !70 d <br />—A Rush <br />By: / Date: Time; <br />/ <br />Rec ' ed By: /yam//p/a�te: Time: <br />Received By:Date: Time: <br />of ����o=• / <br />/`� +/ (/'�� 2 / <br />IPA <br />Corporate Offices d. Laboratory <br />853 Corporation Street <br />Santa Paula, CA 93060 <br />TEL: 8051392.2000 <br />FAX: 8051525-4172 <br />CA NELAP Certificalion No. 01110CA <br />A <br />N <br />Office & Laboratory <br />2500 Stagecoach Road <br />Stockton, CA 95215 <br />TEL: 209/942-0182 <br />FAX: 209/942-0423 <br />CA ELAP Certification No. 1563 <br />Office 6 Laboratory <br />563 E. Lindo Avenue <br />Chico, CA 95926 <br />TEL: 5301343-5818 <br />FAX: 5301343-3807 <br />CA ELAP Certification No. 2670 <br />Field Office <br />Visalia, California <br />TEL: 559!734-9473 <br />Mobile: 5591737-2399 <br />FAX: 559/734-8435 <br />