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CHAIN OF CUSTODY <br /> www.fgl inc.co n 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: welehlodi(&vahoo.com <br /> Contact Person: David Welch <br /> Project Name: ��ki Z 3 J�(O lJ S ffwrJe4'q t7 <br /> Purchase Order Number: v s <br /> g � >� <br /> Quote Numbs: <br /> Rush Analysis: E] 5 Day❑4 Day❑3 Day❑2 Day❑24 hour E <br /> _ O <br /> Rush pro-approval by lab(utitals): <br /> Electronic Data Transfer: [:]No[]State Client Other: <br /> Sampler(s): <br /> _ Va <br /> Sampling Fee: Pickup Fee: `t� !✓ <br /> Compositor Setup Date: Time: <br /> Samp Location Description Date Time t3 v <br /> Num Sampled Sampled <br /> +F <br /> Remarks Relinquished Date: Time: Retmquished 11 Tette Relinquished Date: Time: <br /> Receiv By: Date, Tune: R-6 Date: Tune:0 eived By: Date: Time: <br /> ti 1 a ' �6&c' �12dm mw <br /> Corporate Offices 8 Laboratory Office&Laboratory Office 6 Laboratory Office 6 Laboratory Office&Laboratory <br /> 853 Corporatbn Street 2500 Stagsoosch Road 563 E.Undo Avenue 3442 Empresa Drive,Suite D 9415 W.Goshen Avenue <br /> Santa Panda,CA 93080 Stockton,CA 95215 Chloo,CA 95928 San Luta Obispo,CA 93401 Vw1la,CA 83291 <br /> TEL:(805)392-2000 TEL:(209)942-0182 TEL:(530)343-5818 TEL:(805)783.2940 TEL:(559)734-9473 <br /> Env FAX:(805)525-4172/Ag FAX:(805)392-2003 FAX:(209)942-0423 FAX:(630)3433807 FAX:(805)783.2912 FAX:(559)7348435 <br /> CA FLAP Cadiftelim No.1573 CA ELAP Cer0cation No.1563 CA ELAP Cettilleafion No.2670 CA ELAP Certif attion No.2775 CA EIRP CeRtOcation No.2810 <br />