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CHAIN OF CUSTODY <br /> www.fgl inc.com AND ANALYSIS REQUEST DOCUMENT <br /> OREBRO <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: welehlodi a[7.vahoo.eom <br /> Contact Person: David Welch <br /> Project Name: F `v►w0.�C (� <br /> Purchase Order Number. Y <br /> Quote Number. .y S <br /> Rush Analysis: [:] 5 Day❑4 Day[—]3 Day❑2 Day[:)24 hour $ a CE <br /> Rush pre approval by lab(utials): <br /> Electronic Data Transfer: E]No[—]State ElClient Other: € q r <br /> Sam le s): <br /> Sampling Fee: Pickup Fee: i9 <br /> Compositor Setup Date: Time: $ _ V <br /> Samp Location Description Date Tmte S L e3 t3 d g <br /> Num Sampled Sampled <br /> ►Qcutiwasly Lion w• G:coo wi <br /> Ua�-Sa•, loac; <br /> Remarks Relinquished Date: Time: WR <br /> Date: Time: Relinquished Date: Time: <br /> rOCa nRecery Date: Time: Da : Time: Received By: Date: Time: <br /> 5 � l� 1 5 70M 5aI <br /> MONOMER <br /> Co" raft Oflleea A Lab-*" om"a Laberacerq orale.a taberatary owl"a l a wfft ry ORbe a Lebo twy <br /> 96s Corporotlon Street 2600 SW"coaeh Road 503 E.Undo Avenue 3442 Empresa Drlve.Sulte D 9415 W.Goshen Avenue <br /> Sarda PauK CA 93080 Stodit%CA 96215 Chico.CA 95828 Sen Luis Obispo,CA 93401 VbaW CA 93291 <br /> TEL(005)392.2000 TEL:(209)942-0182 TEL.:(530)343.5819 TEL(MS)793-2940 TEL(559)734-9473 <br /> Env FAX:(903)626.4172/Ag FAX:(806)392-2003 FAX:(209)942-0423 FAX:(630)343 3907 FAX:(605)793-2912 FAX:(SS8)734-84M <br /> CA ELAP C6f&kx Son N0.167s CA ELAP CoMcatim No.1583 CA ELAP Certibnat7 No.2670 CA El AP CerMication No.2775 CA EDLP CerOScat%M No.2810 <br />