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<br />CHAIN OF ,CUSTODY <br />www.fgliiit.com <br />Customer Copy (2 of 3) <br /> <br /> <br />Special EIWIRONMENTAL -- AGRICULTURAL <br /> <br />Analytical Chemists <br /> <br />H 1 111 111 1111 1.1 Oil 1 1 ' 35730.02/06/2017 <br />r <br />TEST DESCRIPTION - See Reverse side for Conta*r, Preservkive and Sampling information <br />Client: <br />Address: <br />Phone: <br />Contact <br />Project <br />Purchase <br />Quote <br />San Joaquin County EHD <br />San Joaquin Co. Environmental Health Dep <br />Water Quality Division - <br />Attn: Rodney Estrada <br />1868 East Hazelton Ave. <br />Stockton, CA 95205 <br />(209)468-0331 Fax: <br /> <br />Person: Rodney Estrada <br />Name: <br />Order Number: <br /> <br />Number: ST 20160309-01 Method of Sampling: Composite(C) Grab(G) Type of Sample **SEE REVERSE SIDE** Potable(P) Non-Potable(NP) Ag Water(AgW) Bacti Type: Other(0) System(SYS) Source(SR) Waste(W) Bacti Reason: Routifte(ROUT) Repeat(RPT) Replace(RPL Other(0) Special(SPL) Coliform-Colilert-P/A 120m1(PBa)-Na2S203 General Mineral 250m1(P)-HNO3 , 16oz(P), 8oz(P) Field Test-Field pH !!pl I = 15 MINUTE HOLD TIME!! Field - pH Date Field - pH Time .k <br />Sampler(s) <br />Sampling <br />Compositor <br />Fee: Pickup Fee: <br />Setup Date: / Time: / <br />Lab Number: STK 3-17919 <br />Num <br />Samp Date - . <br />Location Description Sampled <br />Time <br />Sampled <br />I G DW 1 1,1,1 <br />Remarks: Relinquished Date: Time: <br />' 1\'•A ", l'%,. if 7..1 <br />Relinquished Date: Time: Relinquished Dale: Time: <br />Received By: Date: Time: Received By: Date: Time: Received By: Date: Time: <br />Corporate Offices & Laboratory Office & Laboratory Office & Laboratory Office & Laboratory Office & Laboratory <br />853 Corporation Street 2500 Stagecoach Road 563 E. Lindo 3442 Empresa Drive, Suite D 9415 W. Goshen Avenue <br />Santa Paula, CA 93060 Stockton, CA 95215 Chico, CA 95926 San Luis Obispo, CA 93401 Visalia, CA 93291 <br />Phone: (805) 392-2000 Phone: (209) 942-0182 Phone: (530) 343-5818 Phone: (805) 783-2940 Phone: (559) 734-9473 <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