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CHAIN OF CUSTODY <br /> www.fgl inc.corn AND ANALYSIS REQUEST DOCUMENT <br /> Client: Live Oak Geo Environmental b Number: TEST DESCRIPTION AND ANALYSES REQUESTED <br /> Customer Number: 3016608 <br /> Address: 407 W.Oak Street <br /> Lodi, CA 95240 <br /> Phone: (209)369-0375 Fax: (209)369-0375 <br /> Email Address: welehlodi(cDvahoo.Com J— <br /> Email <br /> Contact Person: David Welch V0 <br /> Project Name: O Z <br /> Purchase Order Number: <br /> Quote Number. <br /> Rush Analysis: E15 Day 4 Day E]3 Day 2 Day 24 hour i <br /> Rush pre-approval by lab(initals): <br /> Electronic Data Transfer. E]No❑State E]Ctient Other: <br /> ^ _ y <br /> Samp"s): O o <br /> Sampling Fee: Pickup Fee: -6 Q` <br /> Compositor Setup Date: Time. <br /> Samp Location Description Date Time Z► � t3 d e <br /> Num Sampled Sampled <br /> 1 1'Za.; w�nr�'✓ 5—I'1-iq B: u� G Q <br /> Remarks Relmqu' Date: Time: Relinquished Date: Time: Relin 'lied Date: Time: <br /> -�-�-►� 9 .1 f-,1�t<. -1 7—t �b 5 (T ( (moo <br /> Received SY Date: Time: Receiv D te: Time: Rx 'ed g: Dat Time: <br /> Corporate Offk a a Laboratory 0moo a Laboratory 011iOa a Laborate Oltlos A Laboratery OMee a Laboratory <br /> 853 Corporation Street 2500 Stagecoach Road 583 E Undo Ave 3442 Empresa Drive,Suite D 9415 W.Goshen Avenue <br /> Sento P a.CA 93oeo Stockh n.CA 95215 Chico,CA 959 I�IOds Obispo,CA 83401 Via"CA 93291 <br /> TEL(805)392-2000 TEL:(200)942-0192 TEL:(530 919 TEL:(80')793-2940 TEL(50)734-9473 <br /> Env FAX:(805)525.4172/All FAX(806),192-2083 FAX:(209 42.0423 FAX:(530)143-3807 FAX:(805)783.2912 FAX:(659)734.8435 <br /> CA ELAP Cer"cation No.1573 CA ELAP CeiNFIca on No.1563 CA ELAP No. (3 CA FLAP CertlSeation No.2775 CA ELAP Cmtl6oadon Pio.2810 <br />