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n i <br />EfYV_IROiY ILNTAL"''-= �AGRICU13*l11iA1,_ <br />Awilylicial Chemists <br />www.fglinc.com <br />CHAIN OF CUSTODY <br />AND ANALYSIS REQUEST DOCUMENT <br />Client: LIVE C KV- GfA�JJvtteol�m�r.� L <br />Offlco & Laboratory <br />Lab Number: <br />Office & Laboratory <br />Office & Laboratory <br />653 Corporation Street <br />2500 Stagecoach Road <br />563 E. LlndoAvenue <br />TEST DESCRIPTION AND ANALYSES REQUESTED <br />9415 W. Goshen Avenue <br />Customer Number: ?gyp t l,9 1. O <br />Stockton, CA 95215 <br />ako <br />4101 <br />Visalia. CA 93291 <br />TEL: (805)392-2000 <br />TEL: (209)942-0182 <br />TEL: (530)343-5818 <br />TEL: (805)783-2940 <br />TEL: (559)734-9473 <br />Env FAX: (805)525.4172 /Ag FAX: (805)392-2063 <br />FAX: (209)942-0423 <br />FAX: (530)343-3607 <br />Address: L40 -1W UA;I- S -r. <br />FAX: (559)7348435 <br />CA ELAP Certification No. 1573 <br />CA ELAP Certification No. 1563 <br />CA ELAP Certification No. 2670 <br />CA ELAP Certification No. 2775 <br />CA ELAP Certification No. 2810 <br />LO,S> t C^ g T 2-.r-10 <br />Phonc:(7- '63 (,`l' 03-)5 Fax: <br />Email Address: �by�� (o a9-I0vu <br />Contact Person: f1; l a y (LwPN C C 0 <br />Project Name: Rfr, i N W rR-rl&'R <br />Purchase Order Numlxx: <br />t7 <br />4 <br />d0 <br />a <br />Quote Number: <br />O <br />V <br />B <br />t <br />$ <br />_ <br />O <br />I <br />a <br />L s <br />I <br />E <br />� - <br />V <br />Rush Analysis: E]5 Day F]4 Day [—]3 Day E]a 2 Day ❑ 24 hour <br />Rush pre -approval by lab (htitals): <br />Electronic Data Transfer: No 0 State Client Other: <br />Sampler(s): <br />Pt81�y t�cCo <br />Sampling Fee: Pickup Foe: <br />Compositor Setup Date: Time: <br />Samp Location Description DateTnrte <br />Num Sampled Sampled <br />1 tr.►rrn�E�, X0'1 W. UAK. 10-l5-2-1 9%550 <br />Cs <br />I <br />P <br />ernarks <br />Retie <br />fished <br />Date: <br />Time: <br />Re' quished <br />Date: Time: <br />Relinquished Date: <br />The: <br />(o—Z�-Z t <br />13:20 <br />2 13: <br />low ki <br />low <br />Received By: <br />11-9-A <br />Date: Time: <br />) 0h,51-12, — 13'-Z01 <br />ecrn <br />(�h <br />e: Time: <br />/9-47 <br />e:' <br />Received By:T <br />CT/f <br />\j <br />Corporate Offloos & Laboratory <br />Offlco & Laboratory <br />Office & Laboratory <br />Office & Laboratory <br />Office & Laboratory <br />653 Corporation Street <br />2500 Stagecoach Road <br />563 E. LlndoAvenue <br />3442 Empresa Drive, Sulte D <br />9415 W. Goshen Avenue <br />Santa Paula, CA 93060 <br />Stockton, CA 95215 <br />Chico, CA 95926 <br />San Luis Obispo, CA 93401 <br />Visalia. CA 93291 <br />TEL: (805)392-2000 <br />TEL: (209)942-0182 <br />TEL: (530)343-5818 <br />TEL: (805)783-2940 <br />TEL: (559)734-9473 <br />Env FAX: (805)525.4172 /Ag FAX: (805)392-2063 <br />FAX: (209)942-0423 <br />FAX: (530)343-3607 <br />FAX: (805)783-2912 <br />FAX: (559)7348435 <br />CA ELAP Certification No. 1573 <br />CA ELAP Certification No. 1563 <br />CA ELAP Certification No. 2670 <br />CA ELAP Certification No. 2775 <br />CA ELAP Certification No. 2810 <br />