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i <br /> CHAIN OF CUSTODY <br /> www.fglinc.com AND ANALYSIS REQUEST DOCUMENT <br /> Chen: Live Oak Geo Environmental Lab Number: TEST DESCRION AND ANALYSES REQUESTED <br /> Customer Number: 3016606 /.C�i / <br /> PTI <br /> Address: 407 W.Oak Street (Y <br /> Lodi, CA 95240 <br /> Phone (209)369-0375 Fax (209)369-0375 <br /> Finaa Address: welchlodi@yahoo.com <br /> Contact Person: David W ICh <br /> Project Name: /5"bal, <br /> Purchase Order Number: <br /> Quote Number: r=j <br /> H p <br /> a <br /> Rush Analysis: [] 5 Day a 4 Day❑3 Day❑2 Day❑24 hour o � a � O � <br /> O <br /> Rush pre-approval by lab(mitals): 2 <br /> m mElectronic Data Transfer: []No❑Sute F]taieett Other: � p <br /> Samplc(s): m m % I +3° <br /> c�eG : € € <br /> V- �- <br /> Samplmg Fee: Pickup Fee: rp $ a <br /> Compositor Situp Data: <br /> The E m to F F <br /> Samp Location Description Date Tane Z m <br /> Num Sampled Sampled <br /> -Fravej Slarik— '} leiflL.5 I G X <br /> emarks ftl-quish ate: Time: wished Dat: Time: Rchnquished Date: The: <br /> MM+ brvK&�w�� j� <br /> iia ti DAJ �,,,,s,�i <br /> Received 8Y: Date: Terse: In <br /> e: Time: Re v D e: Time: <br /> Corporate offiooa 8 Laboratory Office A Laboratory Office 6 Laboratory Office,6 Laboratory Office A 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 Sen Luis Obispo,CA 93401 Visalia.CA 93291 <br /> TEL.(805)392-2000 TEL:(209)942-0182 TEL:(530)343-5618 <br /> TEL:(805)783-294D 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)7348435 <br /> CA ELAP Certification N..1573 CA ELAP Certincation No.1563 CA EIRP Certillcatlon No.2670 CA ELAP Certification No.2775 CA ELAP Certification No.2810 <br /> ) I I <br />