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Special <br />CHAIN OF CUSTODY <br />www.fglinc.com <br />Field Copy (3 of 3) <br />1111 11 t 1111 1 1111 11 11 35730:02/06/2017 <br />, <br />TEST DESCRIPTION -4 See Reverse side for Container, Preservative and Sampling information <br />Client: San Joaquin County EHD <br />Address: San Joaquin Co. Environmental Healtli Dep <br />Water Quality Division <br />Attn: Rodney Estrada <br />1868 East Hazelton Ave. <br />Stockton, CA 95205 <br />Phone: (209)468-0331 Fax: <br />Contact Person: Rodney Estrada <br />Project Name: <br />Purchase Order Number: <br />Quote Number: ST 20160309-01 Method of Sampling: Composite(C) Grab(G) Type of Sample **SEE REVERSE SIDE** Potab1e(0 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 120m1(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 />Fee: Pickup Fee: <br />Setup Date: I / Time: / <br />Lab Number: STK 3-17919 <br />Num <br />Samp Date Location Description Sampled <br />Time <br />Sampled <br />1 G DW 1 1,1,1 <br />Remarks: Relinquished Date: Time: Relinquished Date: Time: Relinquished Date: Time: <br />Received By: Date: Time: Received By: Date: Time: Received By: Date: 'Fime: <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