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CHAIN OF CUSTODY <br /> www.fglinc.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 /> Email Address: welchlodi(a)vahoo.com <br /> Contact Person: David Welch <br /> Project Name: Kw4}(✓ n <br /> Purchase Order Number. <br /> Quote Number. y <br /> Rush Analysis: F] 5 Day❑4 Day[—]3 Day❑ 2 Day❑24 hour <br /> Rush pro-approval by lab(ihitals): g <br /> Electronic Data Transfer: ❑No El State OClient Other: e$3 <br /> t <br /> Sampler(s): m <br /> Sampling Fee: Pickup Fee: <br /> Compositor Setup Date: Time: <br /> Samp Location Description Date Time z � lY/ `� v •� <br /> Num Sampled Sampled <br /> �2a►ti�►o�k.- q0-I W. 5;-(9-11 G:too n, Cs P X <br /> Remarks Relinquished Date: Time: Relinquish Date: Time: Relinquished Date: Time: <br /> Received Date: Time: R ve Da Tine: Received By: Date: Tine: <br /> 5 � �q 5 7VI 5 �1 039 <br /> Corporab Offtoes a Labm-tory Oflfee a L.bw-bmy CHI["a Laberatery Oftbs a Laboratory Offt e a Laboratory <br /> 863 Corporation Street 2600 Stagecoach Road 583 E.UndoAvertue 3442 Ffrtpresa Drive,Suite D 9415 W.Goshen Avenue <br /> Saha PauK CA 93080 Stoddon,CA 95215 Chao,CA 95928 San Luis Obispo.CA 93401 Vh"CA 93291 <br /> TEL(805)392-2!300 TEL:(209)942-0182 TQ.:(530)3.43-5810 TEL:(BM783-2940 TEL(559)734-9473 <br /> F-mr FAX(SW)525-4172/Ag FAX:(805)392-2083 FAX:(209)942-0423 FAX:(630)343-3807 FAX:(605)783-2912 FAX:(SS9)734-0435 <br /> CA ELAP certification N0.1573 CA ELAP Cerentxtlal No.1563 CA ELAP Cerefom6on No.2670 CA EAP Certllteabon No.2775 CA ELAP Cerf catlon No.2810 <br />