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<br />CHAIN OF CUSTODY <br />www.fglinc.com <br />Customer Copy (2 of 3) <br /> <br />FGL <br />ENVIRONMENTAL ACIRICLILTURAL <br /> <br />Special <br /> <br />11 1 11 1111 11 1111 IF 1 35730:02/06/2017 TEST DESCRIPTION See Reverse side for Container. Preservative and Sampling information <br />Client: San Joaquin County EHD <br />Address: San Joaquin Co. Environmental Health 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 _45trada ¢4 1....:( fid4A <br />Project Name: ‘1...9 C - i) L <br />Purchase Order Number: C' <br />Quote Number: ST 20160309-01 % 2ik Method of Sampling: Composite(C) Grab(G) Type of Sample **SEE REVERSE SIDE** -.. <br />ir: <br />:t <br />< <br />a. <br />Z <br />.0 <br />a. Bacti Type: Other(0) System(SYS) Source(SR) Waste(W) Bach i 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), 8oziP) Field Test-Field pH !!pH = 15 MINUTE HOLD TIME!! Field - pH Date Field - p11 Time Sampler(s) <br />Sampling <br />Compositor <br />f'CitAC:i S ( 0 \.cii.s-I-Z., c. Nei, 'i_ <br />Fee: Pickup Fee: <br />Setup Date: / Time: / <br />Lab Number: STK 3-17919 <br />Num <br />Samp Date Location Description Sampled <br />Time <br />Sampled <br />1 G DW I 1,1,1 <br />Remarks: Relinquished Date: Time: <br />; . . <br />L (/2/11)01t/ 1';;-'• <br />Relinquished Date: Time: Re inquished Date: Time: <br />Received By: Date: Time: <br />VIS/20' i i'i.il' <br />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