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CHAIN OF CUSTODY <br /> ENVIRONMENTAL AND ANALYSIS REQUEST DOCUMENT <br /> Lab Number: TEST DESCRIPTION AND ANALYSES REQUESTED <br /> Client: Live Oak Geo Envi ron mental 1 k ; s U <br /> s <br /> Customer Number: 3016608 <br /> Address: <br /> 407 W. Oak St. <br /> Lodi, CA 96240 <br /> I. a i, ' i r � �• 7 <br /> Phone: Fax: it i <br /> (209)369-0375 6 t i a <br /> Email Address: abby@logelodi.eom <br /> Contact Person: Abby Racco <br /> Project Name: 4440 E. Cherokee Rd., Stockton, CA <br /> Purchase Order Number: <br /> Quote Number i W o <br /> a - t o E <br /> sampler(s): <br /> i h a og . <br /> Sampling Fee: Pickup Fee: I m m N I z=. ,J Q. # fi <br /> Compositor Setup Date: Time: m cg r .__o- ro <br /> o <br /> m I .... to C2-� <br /> Samp Location Description Date f Time E 8. <br /> Sampled . �n <br /> Num Sampled l Sampled z' f' S 4: r'i r�i •m��l � I�`r t r { <br /> 1 Domestic Well 'f t4 I3 :4 S G . 4 P/G' P -;DW SRC O X X <br /> r r 4 r r <br /> i <br /> t <br /> F r • <br /> t t ' •j i- i - 4 i <br /> F 2 <br /> f -1 i <br /> � i I <br /> i � 1 <br /> ' h 7 <br /> • i_ <br /> Remarks Relinq 'shed Date: Time: Relinquished DD�e: Tio: linquished Date: Time: <br /> i�o t f-1b-7-te /5F:csa �a07,, l 7� <br /> / a <br /> Rc�y: ` / L]ete: Time: Received By: 7Dt ate: rime:J, Received By: Date: Time: <br /> Corporate Offices S Laboratory Office&Laboratory Office&Laboratory Field Office <br /> 853 Corporation Street 2500 Stagecoach Road 563 E.Linde Avenue Visalia,California <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:530/343-5818 Mobile:5591737-2399 <br /> L�• FAX:805/525-4172 FAX:209/942-0423 FAX:530/343-3807 FAX:5591734-8435 <br /> ` CA NELAP Certification No.01110CA CA ELAP Certification No.1563 CA ELAP Certification No.2670 <br />