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ENVIRONMENTAL AND <br /> OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> db Number. t'EST DESCRIPTION AND ANALYSES REQUESTED <br /> Chem Live Oak GeoEnvironmenta <br /> Customer Number 3016608 <br /> Address: 407 W. Oak St. <br /> Lodi, CA 96240 <br /> Phone: (209) 369-0375 Fax <br /> Email Address: abby@logelodi.com _ : <br /> Contact Peson'. Abby Racco <br /> PotawNmncGlendenning, 7001 E. Southland, Manteca, CA 3 <br /> Purchase Order Number' <br /> Quote Number <br /> 0 3 0 <br /> Smnpler(s): a a z o <br /> Rocco <br /> Sampling Fee: Pickup Fee: - m `� " o °•' zz '.. <br /> Compositor Setup Date: 'Time: <br /> o m N Km N �O _ <br /> Samp Location Description Date Tune - E n <br /> rLa <br /> Nunn I Sampled Sampled R z -- a r'n w m m in a- <br /> ? A <br /> 1 Domestic Well `t/*/t6 12:00f^ G 4 P/G P DW SRC O X X <br /> RUSH, <br /> Remarks Relinquished Date Time Relin he Date lino Relinquished Date. Timer <br /> QZ6 <br /> Receir,C�B Date. 7 Ore Rcce�� d Date Tune: <br /> Time: Reeecce/iveedd 6}: ate JTime: <br /> Corporate Offices&Laboratory Office o&Labratory 'OWoo 8 l aborary��.�.v��e .......� Field Office <br /> 853 Corporation Street 2500 Stagecoach Road 563 E.Linda Avenue Visalia,California <br /> Santa Paula,CA 93060 Stockton,CA 95215 Chico,CA 95926 TEL 559/734-9473 <br /> TEL 805/392-2000 TEL:2091942-0182 TEL 530/343-5818 Mobile:559/737-2399 <br /> FAX 805/525-4172 FAX:209J942-0423 FAX 530/343-3807 FAX 559/734-8435 <br /> CA NE LAP Certification No.01110CA CA ELAP Certification No. 1563 CA FLAP Certification No.2670 <br />