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7-W= . <br />f {VIR0 ml {li1L r1Ci€t1C [J[ I"U€ZAt, <br />?\nalvdc'%l Chemists <br />El <br />www.fglinc.com <br />CHAIN OF CUiST®DY <br />AND ANALYSIS REQUEST DOCUMENT <br />LJ <br />Clint Forward Inc. <br />Lab Number: <br />TEST DESCRIPTION AND ANALYSES REQUESTED <br />Customer Number: 3008692 <br />Office & Laboratory <br />853 Corporation Street <br />Address: Ruben Ramirez <br />583 E. Lindo Avenue <br />3442 Empresa Drive, Suite D <br />9418 W. Goshen Avenue <br />Santa Paula, CA 93080 <br />Stockton. CA 95215 <br />Chico. CA 95928 <br />San Luis Obispo. CA 93401 <br />%Asalle. CA 93291 <br />TEL: (805)392-2000 <br />TEL: (209)942-0182 <br />TEL: (530)343-5818 <br />TEL: (805)783.2940 <br />TEL: (559)7349473 <br />Env FAX: (805)525.4172 /Ag FAX: (805)392-2083 <br />FAX: (209)942.0423 <br />FAX: (530)343.3807 <br />FAX: (805)783-2912 <br />FAX: (559)7348435 <br />CA ELAP CenNkation No. 1573 <br />CA ELAP Certification No. 1563 <br />CA ELAP Certification No. 2870 <br />CA ELAP Cert0lcadon No. 2775 <br />CA ELAP Certification No. 2810 <br />9999 S. Austin Rd <br />Manteca, CA 95336 <br />Phone: (209)982-1009 <br />1 <br />(209)9824298 Fax: <br />FinailAddress: rramirezS@republicservices.com <br />Contact Person:niamlfeZ <br />Project Name: �uk�n <br />C <br />Purchase Order Number: <br />Quote Number <br />Rush Analysis: ❑ S Day ® 4 Day ® 3 Day® 2 Day ❑ 24 hour <br />RushPrtipre-approval by inais): <br />Electronic Data TransferNo State cum Ober: <br />�+ <br />Sampl*s): <br />Sampling Fee: Pickup Fee: <br />Compositor Setup Date: Time: <br />R <br />V <br />Bartter Location Description Date Time <br />Num Sampled Sampled <br />A <br />epi cera a�5 —,c1 6'I3o <br />1 <br />EE <br />Remarb <br />Re hod Date: Time: <br />uiehedTune: Relinquishes e: Time: <br />'I /Al <br />C. Time: <br />awed Dy: Tune: Reopived W. Date: Time: <br />Corporate OHlaee & Laboratory <br />Office & Laboratory <br />Office & Laboratory <br />Office & Laboratory IIJ <br />Office & Laboratory <br />853 Corporation Street <br />2500 Stagecoach Road <br />583 E. Lindo Avenue <br />3442 Empresa Drive, Suite D <br />9418 W. Goshen Avenue <br />Santa Paula, CA 93080 <br />Stockton. CA 95215 <br />Chico. CA 95928 <br />San Luis Obispo. CA 93401 <br />%Asalle. CA 93291 <br />TEL: (805)392-2000 <br />TEL: (209)942-0182 <br />TEL: (530)343-5818 <br />TEL: (805)783.2940 <br />TEL: (559)7349473 <br />Env FAX: (805)525.4172 /Ag FAX: (805)392-2083 <br />FAX: (209)942.0423 <br />FAX: (530)343.3807 <br />FAX: (805)783-2912 <br />FAX: (559)7348435 <br />CA ELAP CenNkation No. 1573 <br />CA ELAP Certification No. 1563 <br />CA ELAP Certification No. 2870 <br />CA ELAP Cert0lcadon No. 2775 <br />CA ELAP Certification No. 2810 <br />