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<br />CHAIN OF CUSTODY <br />www.fglinc.com <br />Laboratory Copy (1 of 1) <br /> <br />Special <br /> <br />ENVIRONMENTAL -- AGRICULTURAL <br /> <br />Analytical Chemists <br /> <br />IIIIIIIIIIII1 1111111111111111111111111111111111111 35730.02/06/2017 I TEST DESCRIPTION - See Reverse side for Container. Preservative and Sampling information <br />Client: San Joaquin Count EHD <br />Address: Sim Joaquin Co. Environmental Health Dep <br />Water Quality Division <br />Atm: Rodney Estrada <br />1868 East HazeIton Ave. <br />Stockton, CA 95205 <br />Phone: (209)468-0331 Fax: <br />Contact Person: Rodney Estrada <br />Project Name: .\4.• LW4066.\,. 'PAIS) <br />Purchase Order Number: <br />Quote Number: ST 20160309-01 Method of Sampling: Composite(C) Grab(G) Type of Sample **SEE REVERSE SIDE** Potable(P) Non-Potable(NP) Ag Water(AgW) Bacti Type: Other(0) System(SYS) Source(SR) Waste(W) Bacti Reason: Routine(ROUT) Repeat(RPT) Replace(RPL) Other(0) Special(SPL) • Coliform-Colilert-P/A 1120m1(PBa)-Na2S203 General Mineral 250m1(P)-HNO3 , 16oz(P), 8oz(P) Field Test-Field pH !!pH = 15 MINUTE HOLD TIME!! Field - pH Date Field - pH Time Sampler(s) <br />Sampling <br />Compositor <br />c,,..sts:0 5\4‘040esZrWtA\ <br />Fee: Pickup Fee: <br />Setup Date: / / Time: / <br />Lab Number: STK 070 q v 6.ci 3-17919 <br />Samp <br />Num Location Description Date <br />Sampled <br />Time <br />Sampled <br />I 1V3\1:-\ --'q.) G DW 1 1,1,1 <br />1•'\ <br /> -1 \i,)1A \\•. <br />Remarks: <br />i , .%1•3 S.(k.r <br />Relinquished Date: , .g..nire'R <br /> <br />1 15VA .1:44-- <br />. ished / Date: Time: <br />X/ /lab 7//5/g <br />Re inquished <br />1 AO 11 <br />i Date: Time: <br />1(.4) 104 <br />R 'ved By: Date: Time: Received By: Date: Time: <br /> <br />1/44 ---,-0 , i <br />Re ved By: .. <br />-)10171 <br />Date: Time: <br />topit <br />Corporate Offices & Laboratory Office & Laboratory Office & Laboratory Office & Laboratory Office & Laboratory <br />853 Corporation Street 2500 Stagecoach Road 563 E. Lindo 3442 Empresa Drive, Suite D 9415 W. Goshen Avenue <br />Santa Paula, CA 93060 Stockton, CA 95215 Chico, CA 95926 San Luis Obispo, CA 93401 Visalia, CA 93291 <br />Phone: (805) 392-2000 Phone: (209) 942-0182 Phone: (530) 343-5818 Phone: (805) 783-2940 Phone: (559) 734-9473 <br />Env Fax: (805) 525-4172 / Ag Fax: (805) 392-2063 Fax: (209) 942-0423 Fax: (530) 343-3807 Fax: (805) 783-2912 Fax: (559) 734-8435