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CHAIN OF CUSTODY <br /> • www.fglinc.com AND ANALYSIS REQUEST DOCUMENT <br /> Client: Live Oak Geo Environmental b Number: 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: welehlodi(fDvahoo.com <br /> Contact Person: A <br /> David Welch <br /> Project Name: (7 i <br /> Purchase Order Number: <br /> Quote Number: <br /> Rush Analysis: 1:15 Day E]4 Day F]3 Day 2 Day 24 hour <br /> Rush pre-approval by tab(itiats): <br /> Electronic Data Transfer: [D No❑State ElCtient Other: �CC <br /> Sampler(s): m V <br /> Ba <br /> Sampling Fee: Pickup Fee: `r3 <br /> Compositor Setup Date: Time: $ t` igF <br /> Samp Location Description Date Time Y Lq r3 v z <br /> Num Sampled Samp)ed <br /> 1 120.; w�=�✓ 5-11 iq S: 00 G Q <br /> Remarks Retinqu' ed Date: Time: Relinquished Date: Time: Relin "hed Date: one: <br /> Received By Date: Time: Receiv D it: Ti 14J Roc ' ed[3y: Dat Time: <br /> 15� <br /> Corporate O cs"a Lab -toy Ono•a LaborstUny 0"Ift aMW. 1-?� <br /> Olnee a Laborabery onbe a Laboratory <br /> 853 CorporaWn Street 2500 Stagecoach Road 583 E.Undo A3442 Empreea Dill".Sufte D 6415 W.Goshen Avenue <br /> Sarna Patch,CA 63060 Stockton,CA 65215 Chfoo,CA 9SI(�I Lute Obtapo,CA 93401 VlseOa,CA 63291 <br /> TEL:(805)392-2000 TEL:(209)642-0182 TEL:(530) 1TEL:(805)783.2940 TEL(656)734-9473 <br /> Env FAX:(845)525-41721Ag FAX:(805),192.2083 FAX:(209)942-0423 FAX:(530)143-MFAX:(805)7812912 FAX:(SS9)734-8435 <br /> CA ELAP Certltl No.1573 CA FLAP CerBfleatla+No.15e3 CA ELAP �CA ELAP Cer80oatbn No.2775 CA FLAP CerM$MdM No.2810 <br />