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MOM ENVIRONMENTAL AND <br /> OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> s <br /> It,ab Number- TEST DESCRIPTION AND ANALYSES REQUESTED <br /> — <br /> 45 <br /> fClimt:: Live Oak GeDEnvitonmental <br /> Customer Number: 3016606 <br /> 1Address: 407 W.Oak St. l 1 <br /> Lodi,CA 95240 <br /> Phone Fax: t_ <br /> Email Address: i E - <br /> i� ( t 1 <br /> t Concoct Person: Abby Raaro <br /> Project Name: Fondse Property,21025 S.Carrolton Rd.,Ripon - 1 <br /> Purchase Order Number. a i^ :,.e � <br /> j Quote Number. <br /> 9 16; I i <br /> : <br /> Sampler(s): Jessen Welch � <br /> m a I i <br /> I All <br /> y�y' t <br /> Sampling Fce: Pickuppce: <br /> Compositor Setup Date. Time m El'o"e 0a J � i j f <br /> z <br /> Sump Location Description Date Time <br /> , Num _ Sampled led _ z r , 8m <br /> I ;.-_. _ I coop <br /> Sam I ampled <br /> r <br /> 0 i Travel Blank � G 2 G X <br /> 1Domestic Well_ . _ .711„j G - 3 ,PlG , P ;DW _ SRC. O .-_ _ - 4 - X, _ X � - <br /> r <br /> s <br /> ;.. .__.-- .. .. .... .-. . . . .. .... _. . . a _. .. i,_. .i <br /> 1 77 <br /> IIi 3 F((f <br /> Remarks R linquished Dale. Tim: eli uish d pate: Time: Relinquished Date: Time: <br /> z216 is �/�a�G /w <br /> R /' ed y: Date: Time: R°[/vedd D Time: Received By: e: Tim: <br /> Corporate Offices 6 Laboratory Nlee&Laboratory Omeo 6 Laboratory Fold Ocoee <br /> 853 Corporation Street 2500 Stagecoach Road 563 E.LmdoAvenue Visalia,California <br /> Santa Paula,CA 93080 Stockton,CA 95215 Chico,CA 95926 TEL:559/734-9473 <br /> TEL:8051392-2000 TEL:209P942-0182 TEL:53013435818 Mobile:559/737-2398 <br /> FAX:80515264172 FAX:2091942-0423 FAX:530/343-3607 FAX:5591734.8435 <br /> CA NELAP Certificallon No.01110CA CA ELAP Csr66catlon No.1683 CA ELAP Cart8lca6on No.2670 <br />