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AN 4 <br /> ENVIRONMENTAL CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> Lab Numbe TEST DESCRIPTION AND ANALYSES REQUESTED <br /> F- 1103`503.✓r <br /> Client: Live Oak GeoEnvironmental ` 1 <br /> Customer Number: 3016608 <br /> Address: 407 W. Oak St. i <br /> Lodi, CA 96240 1 <br /> Phone: (209)369-0375 Fax: <br /> Lmaid Address: abby@logelodi.com <br /> Contact Person: Abby RaccoZ9m_ — <br /> Project Name:Ackerman,5861 W. Kile Rd., Lodi,CA >i o <br /> Purchase Order Number. q e o ]V[ <br /> C7 O C9 s3 ^ <br /> Quote Number. <br /> Samplerfs): v 3 9RLr> <br /> f <br /> Sampling Fee: _ Pickup Fee: oft y rn a ? j i <br /> Compositor Setup Date: ----__---- Time: co LV <br /> v°' <br /> Samp( Location Description Date I Time E _ <br /> Num Sampled Sampled 2 :2 r 0- v3 r rR m a <br /> 0 Travel Blank 4.14-za ta1 zo G 2 G X <br /> 1 Domestic Well G 3 :PIG P DW SRC O X X <br /> . . . . . . . . . . . . <br /> Remarks,. VI 'l Relinquished _ Date: Time: Relinquished Dat :n n Time: elfin 'Date: Time: <br /> 7 D ay RU S W /["/7fUI^f 1j1/LfJ/` �} �`ZD 15:7 0 (q 'LV <br /> J Received By: Date: Time: Rccci•e By: Dat : Time: d Da Time: <br /> 20 1 <br /> Corporate Offices&Laboratory Office&Laboratory Office&Laboratory Field Office <br /> 853 Corporation Street 2500 Stagecoach Road 563 E.Undo Avenue Visalia,Califomia <br /> Santa Paula,CA 93080 Stockton,CA 95215 Chico,CA 95926 TEL:559/734.9473 <br /> TEL:80 513 9 2-20 00 TEL:209/942-0182 TEL:530/343-5818 Mobile:559!737-2399 <br /> FAX:8051525-4172 FAX:209/942-0423 FAX:530/3433807 FAX:559/734-8435 <br /> CA NELAP Certification No.01110CA CA FLAP Certification No.1563 CA ELAP Certification No.2670 <br />