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CHAIN OF CUSTODY <br /> ENVIRONMENTAL AND ANALMS REQUEST DOCUMENT <br /> Lab Number: TEST DESCRIPTION AND ANALYSES REQUESTED <br /> Client 'LiWL Oak-Gt.f.�vi✓a.�y t�� <br /> Customer Number: 3,Ot(O(9G$ <br /> Address: H 04 W• 04f. 5k• t <br /> L*At, oA OIC-s4o <br /> Phone: (-J41j)%4-VS-4S Fax:Cao �3G9-d3'7--� <br /> Email Address: 0-4 41a(DSC(9.:-eA+" <br /> Contact Person: AtJ#1 j gWtte <br /> Pmjeet Name: Dilt/ri ?Vo fA+r"-12-13S• JAM "+- <br /> 0. <br /> Purchase Order Number: <br /> Quote Number: } 0 ' <br /> sampler(s): <br /> 33 <br /> c c z :1a <br /> Sampling Fee: Pickup Foe: m g <br /> Compositor Setup Date: Time: <br /> bVMS <br /> V <br /> 3amp Location Description Date Time co <br /> Num Sampled 1Sampled — <br /> O Trywe.l �ilµ•.tw_T � �! G � C� K <br /> 'Dowttst W.All C7 C� 3 P 6• P Srt O X <br /> F-f <br /> Et- <br /> ReZIlaPlffi t- .d <br /> Date: Tim: ltr3inquished Date: Time: Date: Time: <br /> ODate: Time: Received By: ate: Time: ate: T <br /> 7/a7 0 /0/-2— rr <br /> �,a�lro (�o <br /> Corporate Offlc"&Laboratory OfHee a Laboratory Office&Laboratory Field Offi <br /> 853 Corporation Street 2500 Stagecoach Road 563 E.Lindo Avenue llrsalia.CeiiFomia <br /> " Santa Paula.CA 93090 Stockton,CA 95215 Chlor,CA 9$926 TEL:55111734-9473 <br /> TEL:6051392-2000 TEL:209/942.0182 TEL:530!343-5818 Mobile:5591737-2399 <br /> FAX:80515254172 FAX:209/942-0423 FAX:5301343-3807 FAX:559/134-8435 <br /> CA NELAP Certification No.01110CA CA FLAP Certification Na.1563 CA FLAP Certification No.2070 <br />