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J <br /> CHAIN OF CUSTODY <br /> WW W.fgl inc.com AND ANALYSIS REQUEST DOCUMENT <br /> Gent: David Dyson Lab Number: TEST DESCRIPTION AND ANALYSES REQUESTED <br /> Customer Number: 3019291 2,V'31y21 <br /> Address: 30733 S.Tracy Blvd <br /> Tracy,CA 95377 <br /> Phone: (510)364-2966 Fax: m <br /> Finad Address: ddyson3@yahoo.eom <br /> contact Person: David Dyson ° <br /> Project Name: 30773 S.Tracy Blvd,Tracy, CA c <br /> Purchase Order Number: Qp _ <br /> Quote Number: `m <br /> Rush Analysis: 0 5 Day F]4 Day ❑3 Day[:] 2 Day❑24 hour V 8ss E <br /> Rush pre-approval by lab(maims): C <br /> m m <br /> Electronic Data Transfer. D No❑State DClirnt Other: <br /> �f <br /> Sampler(s): <br /> S _ <br /> x <br /> Sampling Fee: Pickup Fee: <br /> Compositor Setup Dale: Time: m F 0 2 <br /> Samp Location Description Date Time <br /> $ $ 'JYYYV Z n <br /> Num Sampledd Sampled m m <br /> r <br /> 1 <br /> Z/1 J24 0910 G DW X X X <br /> Remarks Relinquished Dote: Tine: Relinquished 4D e: Time: Relnqushed Date: Time: <br /> QT100-$40.00;NO3_N-$34.00;Sampling-$90.00 MID f� �V2�j i�� alt/) r � �� �` S -P-10,k2(4 <br /> �a <br /> Fee—$5.00-Total Due-$169.00 (twz, I ���^ I <br /> Receivedn Time: Received By: te: Time: Received By: Date: Time: <br /> By <br /> Corporate Offices&Laboratory Office b Laboratory Office b Laboratory Office&Laboratory Office b Laboratory <br /> 853 Corporallon Street 2500 Stagecoach Road 583 E.Undo Avenue 3442 Empresa Drive,Suite D 9415 W.Goshen Avenue <br /> Santa Paula,CA 93080 Stockton.CA 95215 Chico,CA 95928 San Luls Obispo,CA 93401 Vlsala,CA 93291 <br /> TEL(805)392-2000 TEL:(209)942-0182 TEL:(530)343-5818 TEL:(805)783-2940 TEL(559)7349473 <br /> Env FAX:(805)525-4172/Ag FAX:(805)392-2063 FAX:(209)942-0423 FAX:(530)343--3807 FAX:(805)783.2912 FAX:(559)734-8435 <br /> CA ELAP Certification No.1573 CA ELAP Certification No.1563 CA ELAP Certification No.2670 CA ELAP Cerilfication No.2775 CA ELAP Certification No.2810 <br />