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rG t'_- CHAIN OF CUSTODY <br /> www.fgl inc.corn 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: welehlodiewahoo.eom <br /> Contact Person: David Welch <br /> Project Name: �y�w4)�✓ (� a <br /> Purchase Order Number: £ 1 <br /> Quote Number: <br /> Rush Analysis: El <br /> 5 Day F]4 Day[:]3 Day❑2 Day❑24 hour a C E <br /> Rush pre-approval by lab(initals): <br /> Electronic Data Transfer. E]No El State Daent Other: <br /> Sampler(s): <br /> Sampling Fee: -5Pickup Foe: } <br /> Compositor Setup Date: Tune: <br /> Samp Location Description Date T. z � >✓ t3 d g <br /> Num Sampled Sampled <br /> �a;ti„vw4v <br /> 140-1 w• S t 9-!1 G-m o' G Q <br /> ChvE. Sa., Lod: <br /> Remarks ReEnquished Date: Time: Relinquish Date: Time: Relinquished Date: Time: <br /> 1*44k �--X11-1 2 <br /> Receive Date: Tone: R ive D.1c: Time: Received By: Date: Time: <br /> il5 7 �� <br /> corporal.o"w"A Lab" Wly O floe&LaborHwy ontoe 6 Laberrttot Office&Laboratory Office&Laboratory <br /> 853 Corporation Street 25W Stagecoach Road 583 E.Undo Avemm 3442 Etnpese Drive.Suite D 8415 W.Goshen Avenue <br /> Sella Patna,CA 93080 Stod"i,CA 85215 Chico.CA 85828 Sen L.tds Obispo.CA 83401 V(satl CA 95291 <br /> TEL(805)392-2000 TEL:(209)942-0182 TEL:(530)3435818 TEL:(805)783-2940 TEL:(559)734-9473 <br /> Env FAX:(805)525-4172/Ag FAX:(805)392.2083 FAX:(209)942-0423 FAX:(530)313-3807 FAX:(805)783-2912 FAX:(559)734-8435 <br /> CA ELAP CeRMcaBan N0.1573 CA EIRP C*—-i No.1583 CA ELAP Cer ffteotlon No.2670 CA ELAP Certfficatlon No.2775 CA ELAP Certitleation No.2810 <br />