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CHAIN OF CUSTODY <br /> ENVIRONMENTAL AND ANALYSIS REQUEST DOCUMENT <br /> Lab Number: TEST DESCRIPTION AND ANALYSES REQUESTED <br /> 1339$ 5 <br /> Chem Live Oak GeoEnvironmental <br /> Customer Number: 3016608 <br /> Address: 407 W.Oak SL <br /> Lodi,CA 95240 <br /> Phone: (209)389.0375 Fen: (209)369-0377 <br /> EmeilAddras abbyalogelodi.00m <br /> Confect Pam: Abby Rocco <br /> Pr -Name: Shastri Property,3885 E.Eight Mile Rd.,Lodi 9 <br /> a it <br /> Purchase Order Number: _ <br /> Quote Nlamber. <br /> O <br /> € 8 <br /> i <br /> Sampler(s): Jessen Welch <br /> Sampling Fee: Pickup Fee: z <br /> g <br /> Compositor Setup Date: Time: I k m <br /> Samp <br /> Location Oestri tion Dau Time �f <br /> NIUM Sampled Sampled 2 8 <br /> la <br /> 0 Travel Blank a 113C' G X <br /> Domestic Well G 3 PIG P DW SRC O 4 X X <br /> FT <br /> Remarks <br /> mpWied Time: d Dau: Time: Relmq ed Time: <br /> (s'u <br /> Received By: Date: Time: ved By: Dau: Time: Received By: u: Time: <br /> �4o 1%1, & q)7)10 (1CfJ �4i�1'J 13w <br /> Corporate Offleea 6 Laboratory Office 8 Laboratory Office 6 Labo <br /> 853 Corporation Street 2500 Stagecoach Road ratery Office <br /> 583 E.Undo Avenue ),,,-�TFIeld <br /> a" California <br /> Santa Paula,CA 83060 3todrton,CA 86215 Chko,CA 95828 L 5591734.9473 <br /> TEL 80S✓392.200o TEL:209/942-0182 <br /> TEL:530/343.5818 Mobile:5597737.2399 <br /> FAX:806/525-0172 FAX 2091942-0423 FAX:530f343-3807 FAX:559/7348435 <br /> CA NELAP CertMeatlon No.01110CA CA ELAP Certtficatlon No.1563 CA ELAP Certification No 2670 <br /> f <br />