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www.fglinc.com <br />CHAIN OF CUSTODY <br />AND ANALYSIS REQUEST DOCUMENT <br />Chent: Steris Comoration <br />Lab <br />Number: <br />Office 6 Laboratory <br />Office & Laboratory <br />853 Corporation Street <br />TEST <br />DESCRIPTION <br />3442 Empresa Drive, Suita D <br />9415 W. Goshen Avenue <br />AND ANALYSES <br />Stoctdon, CA 95215 <br />REQUESTED <br />San Luis Obispo, CA 93401 <br />Visalia, CA 93291 <br />TEL (805)392-21700 <br />TEL (209)942-0182 <br />TEL- (530)343-5818 <br />TEL: (805)783-2940 <br />TEL (559)734-9473 <br />Customer Nwnber: 3018091 <br />•�%0 <br />1 [�� <br />FAX: (805)7832912 <br />FAX: (559)734-8435 <br />CA ELAP Certification No.1573 <br />CA ELAP Certification No. 1563 <br />CA ELAP Certification No. 2670 <br />CA ELAP Certification No. 2775 <br />CA ELAP Certification No. 2810 <br />Address: Attn: Ravmond Doerr <br />1880 Industrial Drive <br />Libertwille. Illinois 60048 <br />Phone: (847)367-5275 Fax <br />e, <br />Ema,3 Address: ravmond doerrna,steris.com <br />Contact Person: Ravmond Doerr <br />Project Name: WW Sump -Stockton, CA. Plant <br />Purchase Order Number: <br />_ <br />Quote Number. ST 20180102-02 <br />V <br />a <br />a <br />O <br />E <br />5 Day ❑ 4 Day [] 3 Day ❑ 2 Day ❑ 24 hour <br />Rush Analysis:El <br />Rush pre -approval by lab (inita(s): <br />O <br />a <br />Electronic Data Transfer: El No ❑ State DClient Other: <br />EEE <br />o <br />= <br />n <br />Sampler(s): I a_ \�\i <br />" <br />V <br />Sampling Fee: Pickup Fee: <br />d. <br />5 <br />~ <br />m <br />rn <br />Composior Setup Date: Tune: <br />Samp Location Description Date Time <br />Num Sampled Sampled <br />1 VWV Sump l at ! <br />G <br />2 <br />P <br />NP <br />WW <br />5 <br />X <br />X <br />X <br />X <br />entarks <br />Relinquished Date: Time. <br />`M8 <br />ishcd D tc Tine. <br />11271 <br />Refinquislicd Djic. Tin,: <br />► � � <br />r�-(3� <br />% l7� <br />� �� 1% �� 5 ,� <br />VimIV ���/// <br />ec n 8y: D e: Time- <br />`3 <br />Rece ed B}: A r1c. Time <br />Received By: Date: Time: <br />t �� ��� <br />s <br />Corporate Offices tt Laboratory <br />OMce 6 Laboratory <br />Offlea 6 Laboratory <br />Office 6 Laboratory <br />Office & Laboratory <br />853 Corporation Street <br />2500 Stagecoach Road <br />583 E. Undo Avenue <br />3442 Empresa Drive, Suita D <br />9415 W. Goshen Avenue <br />Santa Paula, CA 83080 <br />Stoctdon, CA 95215 <br />Chico, CA 95928 <br />San Luis Obispo, CA 93401 <br />Visalia, CA 93291 <br />TEL (805)392-21700 <br />TEL (209)942-0182 <br />TEL- (530)343-5818 <br />TEL: (805)783-2940 <br />TEL (559)734-9473 <br />Env FAX: (805)525-4172 /Ag FAX: (805)392-2083 <br />FAX: (209)942-0423 <br />FAX: (530)343.3807 <br />FAX: (805)7832912 <br />FAX: (559)734-8435 <br />CA ELAP Certification No.1573 <br />CA ELAP Certification No. 1563 <br />CA ELAP Certification No. 2670 <br />CA ELAP Certification No. 2775 <br />CA ELAP Certification No. 2810 <br />