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<br />EGIE <br />ENVIRONMENTAL AGRICULTURAL <br /> <br />www.fglinc.corn CHAIN OF CUSTODY <br />AND ANALYSIS REQUEST DOCUMENT <br /> <br />A ria ly I ca I C1c,tiisIs <br /> <br />mint .. Mike Wutzke <br />Customer Number: 3019150 <br />Address: 21600 N. Kennefick Road <br />Acampo, CA 95220 <br />i tho,.: (209)642-5659 Fax: <br />Erna8 Address: mike@diamondtruckbody.com <br />Contact Person Mike Wutzke <br />Project Noon: 21600 N. Kennefick Road, Acampo <br />Purchase Order Number: <br />Quote Number. <br />-Lab Number:- TEST DESCRIPTION AND ANALYSES-REQUESTED Method of Sampling.: Composite (C) Grab (G) Number of Containers 0 Type of Containers: (0)Gtesa (P)Plastic (V)V0A(MT)Metel Tube Potable (P) Non•Potattle (NP) As Water (AgW) i i <br />31 2 -e <br />g <br />11 i <br />a <br />11 <br />i I <br />1 1 I— It- <br />08 <br />! <br />a o <br />1 <br />VI -,-t _.b... Eisler. (Sys) System (MC) Source (W) Wats i <br />I <br />g <br />1 <br />f: <br />k II <br />I <br />(III <br />l <br />E <br />1 g <br /> .g <br />9 <br />€ <br />ri- <br />I `- <br />g 6 <br />.- <br />1 0T-100 zI zI <br />g <br />g'7 <br />Rush pre <br />Electronic <br />Rush Analysis: . 5 Day . 4 Day . 3 Day . 2 Day . 24 hour <br />-approval by tab (Meals): <br />Data Transfer: . No . State .Client Other, <br />Sampler(s), <br />Sampling <br />Comp° <br />G <br />5/54 6 <br />Fee, Pic p Fee: <br />itor Setup Date: Time, <br />Sunup <br />Nuts <br />Locablan Description <br />.. <br />Date <br />:Ivied <br />Time <br />SaMpled <br />1. Well IIVF18?)...pq0c, G 3 P OW SRC 0Th 6 X X X X <br />Remarks <br />QT100-$38.00:NO2_N-$32.00;NO3_N-$32.00; <br />Sampling-$90.00;WD Fee-$3.00 <br />Total Due-$195.00 <br />Rai meshed Date: Time: <br />il <br />Relinquished Date: Time: <br />Lilze/2-3 17040 <br />Datek......1T7 <br />R'dA c... <br />.“ (By: <br />i <br />Daie: Time: <br />1-1/220 I CIS. <br />Received By Data: Time: <br />6t,c c/128/23 1700/LA <br />Receiv E35'- <br />........1,./....) <br />Corporato Offices & Laboratory <br />853 Corporation Street <br />Santa Paola, CA 93060 <br />TEL: (805)392-2000 <br />Env FAX: (805)525-4172 /Ag FAX: (805)302-2063 <br />CA ELAP Certification No.1573 <br />Office & Laboratory <br />2500 Stagecoach Road <br />Stockton, CA 95215 <br />TEL: (209)9.42-0182 <br />FAX: (209)942-0423 <br />CA ELAP Certification No. 1583 <br />Moe & Laboratory <br />5839-. Undo Avenue <br />Chico, CA 95926 <br />TEL: (530)343-5818 <br />FAX: (530)343-3807 <br />CA ELAP Codification No. 2870 <br />Offtaa & Laboratory <br />3442 Emprese Drive, Suite <br />San UN Obispo, CA 93401 <br />TEL: (805)783-2940 <br />FAX: (805)783-2912 <br />CA ELAP Certification No. 2775 <br />Otheo & Laboratory <br />9415 W. Goshen Avenue <br />Visalia, CA 93291 <br />TEL: (559)734-9473 <br />FAX: (559)734-8435 CA ELAP Certification No. 2810