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CHAIN OF CUSTODY <br /> www.fglinc.com AND ANALYSIS REQUEST DOCUMENT <br /> Client: Live Oak Geo Environmental b Nwnber: 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((Dvahoo.eom <br /> A <br /> Contact Person: David Welch to <br /> Project Name: O z <br /> Purchase Order Number. ri) <br /> Quote Number: <br /> Rush Analysis: [—] 5 Day E]4 Day❑3 Day F� 2 Day❑24 hour $ a O <br /> Rush pre-approval by lab(itials): n' <br /> Electronic Data Transfer. 11 No E]State �Ctent Other: <br /> Sampler(s): m z% <br /> .. 8 <br /> Sampling Fee: Pickup Fee: �. y <br /> Compositor Setup Date: Time: <br /> Samp Location Description Date Time <br /> Num Sampled Sampled <br /> 12a; w�..-F�✓ 5-i'1-iq 8: v� G Q <br /> Remarks Relmqu' Date: Time: Relinquished Date: Time: Relin ished Date: Time: <br /> s-� ,-�� 9 ► S7 lojl . - -(� �a 5 ( (moo <br /> Received®y: ^ Date: Time: <br /> ReceivedDie: Time: Rec ' ed By: Dat Time: <br /> i ,CJS: S--1 ? y:/� GJ t�, ,1,� 5�1 (� nov <br /> corperade ORleea a Laboratery ONloe a Laboratory Ole00 a oQlee a Labwftwy orale•a Laboratory <br /> 853 Corpombott Street 2500 Stagecoach Rood 563 E Undo A !` 3442 Empresa Drive,Suite D 9415 W.Goshen Avenue <br /> Santo Patch.CA 93080 StoditM CA 95215 CAioo.CA 95 Ivl Lida Obispo.CA 93401 Visalia,CA 93291 <br /> TEL(805)392-2000 TEL:(209)942-0182 TEL:(530) 18 iEL.(805)76512940 TEL(559)734.9473 <br /> Env FAX(005)525-4172/Ag FAX:(605)392-2093 FAX:(209)442-0423 FAX:(530),143-3807 / 1 <br /> FAX:(805)782912 FAX:(559)734-8435 <br /> CA FLAP CerOtiestim No.1573 CA ELAP Certification No.15e3 CA FLAP No. I� 7�'CA ELAP certification No.2T75 CA ELAP C.ertEfeeflon No.2810 <br />