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a ENVIRONMENTAL <br />Clipq <br />CHAIN OF CUSTODY <br />AND ANALYSIS REQUEST DOCUMENT <br />Lab Number: <br />„4k2i-rrr. <br />TEST DESCRIPTION AND ANALYSES REQUESTED <br />Client: Live Oak GeoEnvironmental <br />Customer Number: 3016608 <br />Address: 407 W. Oak St. <br />Lodi, CA 96240 <br />Phone: (209) 369-0375 Fax: <br />Email Address: abby@logelodi.com <br />Contact Person: Abby Racco <br />Project Name: Martin, 6103 W. Delta Ave., Tracy, CA <br />Purchase Order Number: <br />Quote Number. <br />) I <br />Sumplens): <br />t Sampling Fee: Pickup Fee: <br />Compositor Setup Date: Time: <br />, • <br />, Samp Location Description Date Time <br />Num I <br />0 Travel Blank <br />Domestic Well <br />X <br />Sampled Sampled <br />1141-11; <br />.141-a4 X X G 3 P/G P DW. SRC 0 . . <br />Relinquished Remarks <br />d4 -11-21 t —e-12. <br />Received By: Date: Time: Date: <br />/61 3, 7 Aai <br />Corporate Offices & Laboratory <br />853 Corporation Street <br />Santa Paula, CA 93060 <br />TEL: 805/392-2000 <br />FAX: 805/525-4172 <br />CA NELAP Certification No. 01110CA <br />Office - Laboratory <br />250. tageonach Road <br />on. CA 95215 <br />TEL: 209/942-0182 <br />FAX: 209/942-0423 <br />CA ELAP Certification No. 1563 <br />Field Office <br />Califomia <br />TEL: 559/734-9473 <br />Mobile: 559/737-2399 <br />FAX: 559/734.8435 <br />Office & Laboratory <br />563 E. Linda Avenue <br />Chico, CA 95926 <br />TEL: 530/343-5818 <br />FAX: 530/343-3807 <br />CA ELAP Certification No. 2670 <br />20` <br />f0,41