Laserfiche WebLink
—fiftz- CHAIN OF CUSTODY <br /> • www.fgl inc.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 /> Emaa Address: welchlodi(cDvahoo.com <br /> Contact Person: David Welch <br /> Project Name: Kw4-)�✓ (� aa <br /> Purchase Order Number. Y <br /> Quote Number: <br /> Rush Analysis: [:] 5 Day❑4 Day[:]3 Day❑2 Day❑24 hour $ a C E <br /> Rush pro-approval by lab(i itals): <br /> Electronic Data Transfer. <br /> E]No E]State ElChent Other: <br /> S o <br /> 0 <br /> Sampler(s): <br /> Sampling Fee: Pickup Fee: <br /> Compositor Setup Date: Time: <br /> Samp Location Description Date Tmte Zr Zig v <br /> Num Sampled Sampled <br /> I�thNroe4<.- qo-) w S (9-11 (,:oo ►ti+ G P <br /> enwks Relinquished Date: Time: Relinquish Daze: Time: Relinquished Date: Time: <br /> @L <br /> Received Date: Tine: R e Date: Time: Received bay: Date: Time: <br /> I . J` 7LO 5 P1�1�1 m <br /> Corporate offices A Leborabery Office a Laberasory Of les a Laboratory Office a Laboratory Office&Laboratory <br /> 853 Corporation Street 2000 Staysooadt Road 563 E.Undo Avenue 3442 Empresa Drive.Sulte D 0415 W.Goshen Avenue <br /> Santa Portae CA 93060 Stoddon,CA 95215 Chloo,CA 95928 Sen Luta Obispo.CA 93401 Vtsells,CA 93291 <br /> TEL: )M-2000 TEL:(209)942-0182 711:(530)343-5818 TEL(WS)783-2940 TEL(559)734-9473 <br /> Env FAX(605)625.41721 Ag FAX:(805)4192-2003 FAX:(209)942-0423 FAX:(630)3433807 FAX:(805)783.2912 FAX:("%7.0-8435 <br /> CA ELAP Cerencebw No.1573 CA ELAP CM rnlee8on No.1583 CA ELCerWkatlon f k <br /> No.2670 CA ElAP Ceration N0.ZTTS CA ELAP CertTctlon No.2810 <br />