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CHAIN OF CUSTODY <br /> www.fglinc.com AND ANALYSIS REQUEST DOCUMENT <br /> Analytical Chemists <br /> Client San Joaauin Countv EHD Lab Number: TEST DESCRIPTION AND ANALYSES REQUESTED <br /> Customer Number: 3017919 <br /> Address Water Qualitv Division <br /> Attn: Michael Kith <br /> 1868 East Hazelton Ave. m <br /> CU <br /> Phone: (209)468-3444 Fax R m <br /> Email Address: mkith an.sicehd.com S z <br /> Contact Person: Michael Kith -t <br /> Project Name: v <br /> 2430 N. Murray Rd. Linden a o o a- g <br /> Purchase Order Number: n p y p <br /> > <br /> Quote Number: COm L.t <br /> 1-- m T <br /> U d4 ma p <br /> Rush Analysis: El 5 Day❑4 Day F]3 Day E] 2 Day F] 24 hour @ m oCri <br /> j C <br /> N _ C <br /> Rush pre-approval b}lab(initals): <br /> 136 <br /> m m m <br /> c rP ►" �{w <br /> E � m m o ai g w <br /> Electronic Data Transfer: E]No ❑State OChent Other: U -.o U N z <br /> + m <br /> CD <br /> zp <br /> zm <br /> Sampling Fee: Pickup Fee: q o U G m m y. O �- 3 Y N <br /> Compositor Setup Date: Time: E y F m N <br /> Samp Location Description Date Time < z `° co� V y _�i, m <br /> Num Sampled Sampled <br /> �1 Wellhead i P DW <br /> F-FF F-F-F-F-F-F-F-F-F-F-F-F-F-F-F-F-F-F-F-F-F-F- <br /> Remarks Relinquished Date: Time: Relinquished Date Time Relinquished Date: Time: <br /> Replacement for STK1951713-1. <br /> Received By: Date: Time: Received By: Date: Time: Received By: Date: Time <br /> Corporate Offices&Laboratory Office&Laboratory Office&Laboratory Office&Laboratory Office&Laboratory <br /> 853 Corporation Street 2500 Stagecoach Road 563 E.Lindo Avenue 3442 Empresa Drive,Suite D 9415 W.Goshen Avenue <br /> Santa Paula,CA 93060 Stockton,CA 95215 Chico,CA 95926 San Luis Obispo,CA 93401 Visalia,CA 93291 <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)392-2063 FAX:(209)942-0423 FAX:(530)343-3807 FAX:(805)783-2912 FAX:(559)734-8435 <br /> CA ELAP Certification No.1573 CA ELAP Certification No.1563 CA ELAP Certification No.2670 CA ELAP Certification No.2775 CA ELAP Certification No.2810 <br />