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CHAIN OF CUSTODY <br /> ENVIRONMENTAL AND ANALYSIS REQUEST DOCUMENT <br /> Lab Number TEST DESCRIPTION AND ANALYSES REQUESTED <br /> ,�(�.� I`� 5) <br /> Client: Live Oak GeoEnvironmental j <br /> Customer Number: 3016608 <br /> Address: 407 W. Oak St. <br /> Lodi, CA 96240 <br /> Phone: (209) 369-0375 Fax: <br /> j Email Address: abby@io9eiodl.Com ? ij <br /> Contact Person: Abby Racco <br /> Project Name: 350 E. Critchett Ave.,Tracy, CA 0 a <br /> Purchase Order Number: ¢ 2 <br /> Quote Numbero> �T <br /> Sampler(s): <br /> Pie, P U a <br /> I��iiCO a ¢ m m in <br /> E <br /> Sampling fee: --_ Pickup Pee: a .� w a o zz <br /> mm _ m _x } <br /> Compositor Setup Date Time: rn 8 °'~ o E <br /> \J <br /> o 8 a 3 „' la <br /> Saint, - Location Description - Date "rime E $ <br /> a' <br /> o <br /> Num Sampled Sampled z' g o" <br /> m w <br /> 1 Domestic Well 2/S�ZG j �;5 S G 4 P/G P DW SRC O { X X f <br /> � I <br /> ' � f <br /> i <br /> I <br /> Remarks Relinquished DatI"ime: Relinquished Date: Time: Relinquished Date: Time: <br /> f9 2/s 6 iz:�to p ,e� ► �qb G�-S 2 2� os9 <br /> Received By: Date: Time: Received By: Tim' e: Received By: Date: TimeJatj <br /> n5 4D /� <br /> Corporate Offices 8 Laboratory OHice 8 Loboratory Office 8 La oral ry Field Office <br /> 853 Corporation Street 2500 Stagecoach Ro tl 563 E.LmdoAvenue Visalia,Califomia <br /> Santa Paula,CA 93060 Stockton,CA 95215 Chico,CA 95926 TEL:559!734-9473 <br /> TEL:805/392-2000 TEL 209/942-0182 TEL:530/3435818 Mobile:559!737-2399 <br /> FAX:805/525-4172 FAX 209/942-0423 FAX:530/343-3807 FAX:559!7348435 <br /> CA NELAP Certification No.01110CA CA ELAP Certification No.1563 CA ELAP Certification No.2670 <br /> ,1 <br />