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- - CHAIN OF CUSTODY <br /> ENVIRONMENTALwww. lint.com <br /> fg AND ANALYSIS REQUEST DOCUMENT <br /> Analytical Chemists <br /> Client San Joaauin Countv EHD Lab Ntttnber: TEST DESCRIPTION AND ANALYSES REQUESTED <br /> Customer Number: 3017919 <br /> Address: Water Qualitv Division <br /> Attn: Michael Kith <br /> 1868 East Hazelton Ave. m <br /> Phone: (209)468-3444 Fax: <br /> CL <br /> Email Address: mklthan.sicehd.com S <br /> Contact Person: Michael Kith -P a' <br /> Project Name: 2465 W.Vernalis Rd. Tracy ¢ c2 o <br /> Purchase Order Number: e O y r Q <br /> x <br /> Quote Number: —�� s z <br /> Rush Analysis: S Day❑4 DayE] Day 2 Day 24 hour m m ` y iz <br /> m C <br /> Rush pre-approval by lab(initals): oy a m ot� m y <br /> E N m o m ri o m m <br /> Electronic Data Transfer: ❑No❑State Client Other: U a 2 3 N <br /> Sampler(s): m t 0- <br /> E m m z ? �_a o z z� <br /> K' aK <br /> o � L <br /> ro L) m <br /> � o �'m <br /> Sampling Fee: Pickup Fee: 4 B O ► —' o <br /> o o m o N m <br /> Compositor Setup Date: Time: E y F` F —, m U) <br /> Samp Location Description Date Time ,�� z 1 <br /> Num Sampled Sampled(((` <br /> 1 Wellhead t�t��� �[G_[T_Ip_F_ DW F—F—F—F—F-1�—F—F—F—F—F—F—F—F—F—F— I F_ <br /> Remarks Relinquished Date: Time: Relinquished Date: Time: Relinquished Date: Time: <br /> Replacement for STK1952242-1. <br /> Rece d 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 Avenue 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 /> TEL:(805)392-2000 TEL:(209)942-0182 TEL:(530)343-5818 TEL:(805)783-2940 TEL:(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 <br /> CA ELAP Certification No.1573 CA ELAP Certification No.1563 CA ELAP Certification No.2670 CA ELAP Certification No.2775 CA ELAP Certification No.2810 <br />