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oMlScVa (a) <br />'www.fglinc. com <br />TEST DESCRIPTION AND ANALYSES REQUESTED <br />Address: <br />Phone: <br />Quote Number: <br />3 <br />1<50 <br />G DW X <br />I A x <br />Remarks Rebnquished <br />Time:Due:Time:Time <br />0 <br />£ <br />0 <br />I 1 8 <br />e <br />Corporate Offleoa & Laboratory <br />853 Corporation Stroot <br />Santa Raida, CA 0'3000 <br />TEL: (805)302-2000 <br />CA ELAP CortillcatJon No. 1573 <br />Chen:: Allison Thompson <br />Customer Number 3019704 <br />15817 E. Eugenia Ave. <br />Ripon, CA 95366 <br />Jed Thompson (408)823-3830 <br />Total Due <br />i <br />CHAIN OF CUSTODY <br />AND ANALYSIS REQUEST DOCUMENT <br />Samp <br />Num <br />I <br />t <br />I <br />Lab Number: <br />I <br />5 <br />$1s, <br />o <br />1^3 <br />§ KI & <br />k <br />| <br />a <br />B& <br />§ <br />I <br />5 I <br />I <br />1 <br />1 <br />I <br />0i <br />§ <br />I <br />I <br />I <br />D*!e: Time: <br />i/rg/zc <br />I oE <br />I <br />■3 <br />I z <br />| [cbent Other: <br />V <br />2. <br />££3l>0PA\ VAfr T <br />?o <br />1 <br />Tte <br />Sampled <br />E/m <br />Dale <br />Sampled <br />EHVIROHMF.riTAI. t? AGRICULTURAL <br />AiKil)’liGil CllCitiiSIS <br />Reccrye^ I <br />Rush Analysn; | | 5 Day | | 4 Day | | 3 Day J | 2 Day | | 24 hour <br />I <br />3 <br />I <br />Rush pre-approval by lab (tnrtat): <br />EJccnonk Data Transfer: | | No | | Stole <br />ii <br />II <br />if <br />h <br />H <br />h 0 <br />fg <br />i as <br />I <br />bp <br />■ Is <br />Lot/J Cw&'M'l <br />Ct TTt <br />SrunplerfJyx I . <br />Sampling Fee:Pickup Fee: <br />Dale; Tine: I <br />iW5 <br />| Received By. Date: <br />Offloo & Laboratory Offioo & Laboratory <br />2500 Stagocoach Road 563 E. Undo Avonuo <br />Stockton, CA 05215 Chico, CA 05026 <br />TEL: (200)042-0182 TEL' (530)343-5818 <br />CA ELAP Cortlficabon No. 1563 CA ELAP CtMlihcaUon No. 2670 <br />(707)354-8831 Fa, <br />Email Address: thomps.allison@gmail.eom <br />Contact Person: AlllSOn Thompson <br />Project Name 15817 E. Eugenia Ave, Ripon, CA <br />Purchase Order Number: <br />Dae: . Tine: Relinquished <br />Date: . Time: Received By Date: <br />//zg/ZL. Ml- <br />Offloo & Laboratory <br />3442 Emprosa Driv®. Suda D <br />San Lula Obispo, CA 03401 <br />TEL: (605)783-2040 <br />CA ELAP CortScmion No. 2775 <br />Office & Laboratory <br />8411 W. Goshon Avonuo <br />Vlsolto, CA 03291 <br />TEL: (550)734-9473 <br />CA ELAP Codification No. 2810 <br />Compositor Setup Date:Time: <br />Location Description