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Special CIUM OF CUSTODY <br />Pe www. fgltnc.com <br />Laboratory CO' Pay (1 of 3) <br />Corporate Offices & Laboratory <br />35730:02/06/2017 <br />1'L -Si' D SC..RIPHON Sec Rc%ersc side for Curtain r. Preservative ulld Sampling inforimumn <br />Client: San Joaquin County EH)� <br />Office & Laboratory <br />853 Corporation Street <br />2500 Stagecoach Road <br />563 E. Lando <br />3442 Empresa Drive, Suite D <br />9415 W. Goshen Avenue <br />Santa Paula, CA 93060 <br />i <br />Chico, CA 95926 <br />San Luls Obispo, CA 93401 <br />Visalia, CA 93291 <br />Phone: (805) 392-2000 <br />Phone: (209) 942-0182 <br />Phone: (530) 343-5818 <br />i <br />Address: San Ybaquin Co. Environtrental Health Dep <br />Env Fax: (805) 525-4172 / 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 />n <br />Water Quality Division <br />j <br />Attn:-Rodney Estrada <br />1868 East Hazelton Ave. <br />W <br />Stockton, CA 95205 <br />3 <br />a <br />Phone: (209)468-0331 Fax: <br />Contact Person: Rodney Estrada <br />Lv <br />Project Name: � ).AL3, L C. L61v" by, %41C'A' <br />0 <br />h <br />2 <br />� <br />Purchase Order Number: <br />Quote Number: ST 20160309-01 <br />o <br />w <br />rw <br />a <br />;r <br />y <br />a <br />F <br />o <br />w <br />A <br />o <br />Sampler(s) { 11 <br />�1 t <br />rw 1, rr�fb <br />U <br />r <br />= <br />y <br />Sampling Fee: Pickup Fee: <br />Compositor Setup Date: _/_/_ Time: _/_ <br />E <br />rn <br />0 <br />5 <br />o <br />E <br />ria <br />Z <br />a, <br />p <br />n <br />a <br />rn <br />x6 <br />a u <br />V Z <br />c .. <br />U <br />€= <br />= E <br />O <br />g z <br />x <br />g <br />-'t <br />u z <br />is <br />�= <br />[— II <br />v <br />E <br />A [— <br />a o <br />v <br />a 2 <br />Lab Number: STK 3-17919 <br />Sam p <br />Date <br />Time <br />Num <br />Location Description <br />Sampled <br />Sampled <br />u <br />M <br />F- <br />o <br />a <br />rri <br />$ <br />'20 <br />c N <br />U — <br />„o <br />S r <br />p <br />u. _: <br />v <br />w V. <br />IA <br />VJt>"(y2 <br />c <br />DW <br />1 <br />t,t,t <br />XQL <br />, <br />i <br />Remarks: <br />Rel'n u' ed Da Time: <br />��il> <br />te: <br />Relinquished DaTime: <br />Rel' quecJ. Date �im <br />-f? <br />w- tim <br />ReceivedCW, Da Time: <br />Receiv y: ate: Time: <br />Received By: Date: Tit: <br />Corporate Offices & Laboratory <br />Office & Laboratory <br />Office & Laboratory <br />Office & l.abaratory <br />Office & Laboratory <br />853 Corporation Street <br />2500 Stagecoach Road <br />563 E. Lando <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 Luls Obispo, CA 93401 <br />Visalia, CA 93291 <br />Phone: (805) 392-2000 <br />Phone: (209) 942-0182 <br />Phone: (530) 343-5818 <br />Phone: (805) 783-2940 <br />Phone: (559) 7349473 <br />Env Fax: (805) 525-4172 / 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 />