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CHAIN OF CUSTODY <br /> • www..fgl inC.COM AND ANALYSIS REQUEST DOCUMENT <br /> chen►: Live Oak Geo Environmental b Number: TEST DESCRIPTION AND ANALYSES REQUESTED <br /> Customer Number: 3016608 O <br /> Address: 407 W.Oak Street <br /> Lodi. CA 95240 <br /> Phone: (209)369-0375 Fax: (209)369-0375 <br /> Email Address: welchlodi(oavahoo.com <br /> A <br /> David Welch <br /> Contact Person: <br /> Project Name: d Z <br /> Purchase Order Number: v <br /> Quote Number: <br /> Rush Analysis: 1:3 5 Day❑4 Day F�3 Day 2 Day[:]24 hour E <br /> Rush pre-approval by lab(iheals): <br /> Electronic Data Transfer: No[:]State Client Other: <br /> Sampler(s): V P,&CCD z <br /> Sampling Fee: Pickup Fee: -6 <br /> Compositor Setup Date: Time: $$ F= F <br /> Samp Location Description Date Time z �` � 1 z <br /> Num Sampled Sampled <br /> 1 120►; win.-�✓ 5-1�-i`f S: Lao G Q � <br /> Remarks Retinqu' ed Date: Time: Relinquished <br /> Date: Time: Relin 'bed Date: Tune: <br /> 5, <br /> Received By Date: Time: Receiv Die: Time: Roe 'ed g: Dat Time: <br /> i 7 S- Lq 0)(0-J) <br /> corporate Atflo a a Laboratory Of11ee a Laboratory p1tloe a Oftlee a Laboratory ONLae a Laboratory <br /> on Corporation Street 2500 Stagecoach Road 583 E Undo A 5442 Empresa Drive.Sulte D 9415 W.Goshen Avenue <br /> Serbia para,CA 93080 Stocith n,CA 95215 Chico.CA 95 ��d�l Lula Odapo.CA 95401 Viaetle.CA 03291 <br /> TEL(B05)s92-z000 TEL:(209)942-0182 TEL:(5M 1e iEl:(905)783-2940 TEL(659)734-9473 <br /> 6w FAX(805)525-4172/Ag FAX:(805)392-2083 FAX:(209)842-0423 FAX:(5311)343-5807 /`FAX:(805)78b2912 FAX:(5W)734.8435 <br /> CA EtAP Certlf CROM No.1573 CA ELAP CetOflcaHon No.1553 CA ELAP No. (3"�-'CA ELAP Cereficatlon No.2775 CA EL/W Certdicatim No.2810 <br />