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—-OGG'-E 7 CHAIN OF CUSTODY <br /> www.fgl inc.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(7vahoo.com <br /> Contact Person: David Welch <br /> Project Name: �w%.—gL'�✓ i <br /> Purchase Order Number: <br /> i' <br /> Quote Number: <br /> Rush Analysis: F1 5 Day[—]4 Day 0 3 Day❑ 2 Day❑24 hour i E <br /> _ O L <br /> Rush pro-approval by lab(initals): <br /> Electronic Data Transfer. No -tete ❑Client Other: <br /> Sampler(s): <br /> ���� (FSG(� � , � � `•�� —t' <br /> Q <br /> Sampling Fee: Pickup Fa: 5 <br /> Compositor Setup Date: Time: $ 1= <br /> Samp Location Description DateTmm <br /> Num Sampled Sampled <br /> 1Qathwoe4t.- q0-) Vi. <br /> S 19-11 G.t3o ,,, G 1 P X <br /> Remarks Relinquished Date: Time: Relinquish Date: Time: Relinquished Date: Time: <br /> AMP- 11--,6 <br /> Receive Date: Tune: Da : Time: Received By: Date: Time: <br /> 5 �J/l l R e5 70M 9 P I I�3 <br /> Corporate offloss a Laboratory Offtas 3 L.aboraesy office&Laboratory Offlae 6 Laboratory Moo 8.Lobosatoy <br /> 883 Corponstbn Street 2800 Sta(yeooaelt Road 583 E.Undo Avenue 3442 Empresa Drive•Suite D 9415 W.Goshen Avenue <br /> Santa Paula.CA 95080 Stockton,CA 95215 Chfoo,CA 95928 San Luka Obispo,CA 93401 Viselta,CA 93291 <br /> TEL(805)392-2000 TEL:(209)942-0182 TEL:(530)3435818 TEL:(805)783-2940 TEL(559)7349473 <br /> Env FAX:(80-)828-4172/Ag FAX(808)392-2083 FAX:(209)942-0423 FAX:(530)343 807 FAX:(805)783-2912 FAX:(-"9)7348435 <br /> CA ELAP Ce M108lon NMIS73 CA ELAP Cert>ttea8on No.1553 CA FLAP certification No.2670 CA ELAp CertJ7featlon No.Zr7S CA EMP Ceraft abon No.2810 <br />