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Special CHAIN Or CUSTODY <br />www.fglinc.com <br />Field Copy !(3 of 3) <br /> <br />CIIVIRONMENTAL - AGRICULTURAL <br /> <br />111114111111111111111111111111 11111111111111111H • <br />,,• <br />'...1 TEST DESCRIPTION - See Reverse side for Container, Preservative and Sanwling information , <br />Client: San Joaqu County EHD <br />Address: San Joaquin Co. Environmental Health Dep <br />Water Quality Division <br />Attn: Rodney Estrada <br />1868 East Haze1ton 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** Potable(P) Non-Potable(NP) Ag Water(AgW) Sampled Bacti Type: Other(0) System(SYS) Source(SR) Waste(W) Bacti Reason: Routine(ROUT) Repeat(RPT) Replace(RPL) Other(0) Special(SPL) "g <br />0 <br />a r...) oa <br />—' < <br />< -i <br />Sampler(s) <br />Sampling <br />Compositor <br />Fee: Pickup Fee: <br />Setup Date: / / Time: / <br />Lab Number: STK 3-17919 <br />Samp <br />Num Location Description Date <br />Sampled <br />Time <br />0 Travel Blank G LBW 4 ,.: _ <br />1 G DW 4 <br />Remarks: Relinquished Date: Time: <br />1 <br />Relinquished Date: Time: Relinquished Date: Time: <br />Received By: Date: Time: Received By: Date: Time: Received By: Date: Time: <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 9415W. 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