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EGIE CHAIN OF CUSTODY <br /> ENVMONHENTALwww.fglinc.com AND ANALYSIS REQUEST DOCUMENT <br /> Client: Live Oak Geo Environmental Lab 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: welchlodi()vahoo.com <br /> Contact Person: David Welch <br /> Project Name: V.0uriwk+(.,- C) <br /> Purchase Order Number: a1n <br /> Quote Number- <br /> Rush <br /> umberRush Analysis: F] 5 Day[—]4 Day❑3 Day❑2 Day❑24 hour <br /> E <br /> Q <br /> Rush pro-approval by lab(ititaLs): <br /> Electronic Data Transfer: ❑No[D StateClient Other: <br /> o <br /> Sampling Fee: Pickup Fee: u <br /> Compositor Setup Date: Time: f is •� <br /> Samp Location Description Date Tmte <br /> Num Sampled Sampled <br /> ) 1Qaitiwoek.- x#01 w• S-(9-l1 G,00 ,,, G � ? � <br /> vim- S-l., Loot; <br /> enwks Relinquished Date: Time: Relinquish Date: Time: Relinquished Date: Time: <br /> Receiv Date: Tine: R e D.1c: Time: Received By: Date: Time: <br /> 5 7bill 5P���� <br /> Corporate Orators a Leboratary onto•a Laboratory orate.&tabenkery oralee a Labors" oleo•6 Laboratory <br /> Boa Corporation Street 2000 Stapeooadn Road 563 E UntloAvenue 3442 BWwa Drive.Suite D 9415 W.Goshen Aventte <br /> Santa PauK CA 93000 Stodaon,CA 90215 Chico,CA 95928 Sen We Obispo,CA 93401 VMUM CA 93291 <br /> TEL(805)392.2000 TEL:(20%942-0182 TEL:(530)3435818 TEL(605)783-2940 TEl (559)734.9473 <br /> Emr FAX:(800)025-4172/Ag FAX:(800)392-2083 FAX:(209)942-0423 FAX:(530)3133807 FAX:(005)7832912 FAX(SW734-8435 <br /> CA ELAP C rerica0on N0.1573 CA ELAP Car—it&1503 CA ELAP CertHlcation No.2670 CA FLAP Cert)lketion No.2775 CA ELAP Cergicafion No.2810 <br />