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www.fglinc.com <br />CHAIN OF CUSTODY <br />AND ANALYSIS REQUEST DOCUMENT <br />Client: VVC Off- y -e— <br />Lab Nwnber: <br />Office & Laboratory <br />Offico & Laboratory <br />Office & Laboratory <br />TEST DESCRIPTION AND ANALYSES REQUESTED. <br />2500 Stagecoach Road <br />Customer Number: <br />3442 Empresa Drive, Suite 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: (605)392-2000 <br />TEL: (209)942-0182 <br />TEL: (530)343-5818 <br />Address: "-1 W . Oaf S'} <br />L,.,vL• GA 01Y z'`t 0 <br />TEL: (559)734-9473 <br />Env FAX: (805)5254172 / Ag FAX: (805)392-2063 <br />FAX: (209)942-0423 <br />FAX: (530)343-3807 <br />FAX: (805)783-2912 <br />FAX: (559)7348435 <br />CA FLAP 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 />Phone: j„ lJ 3(p°I - 03"1 t Fax: <br />Email Address: 091* 5 Q le�OCA, -- <br />Contact Person: Abbv) Q0.te-o <br />Contact <br />Project Name: 1" v%woikt-w <br />Purchase Order Number: <br />Quote Number: <br />Vss <br />$ <br />$ <br />$ <br />_ <br />° <br />_ <br />4 <br />_ <br />O L <br />g; <br />F{ <br />�D ffi <br />u K <br />v Z <br />Rush Analysis: ❑ 5 Day ❑ 4 Day ❑ 3 Day ❑ 2 Day ❑ 24 hour <br />Rush pre -approval by lab (init&): <br />Bectronic Data Transfer: No Elstate ElChem Other: <br />Sampler(s): A' <br />I'- <br />Sampling Fee: Pickup Fee: <br />Compositor Setup Date: Time: <br />Samp Location Description Date Time <br />Nttm Sampled Sampled <br />lo:ao <br />G <br />1 <br />Y_ <br />Remarks <br />RetinqjOsked <br />Date: <br />� ,z-►�•zl <br />Time: <br />� :�O <br />Relinquished <br />��� <br />Date: <br />�Z/r�/2f <br />Time: <br />laza <br />Relinquished <br />(� I i5 <br />Date: Time: <br />ZI I U jS <br />Received By: <br />Date: <br />Time; <br />R ed Date: <br />Time: <br />Received By: <br />Date: Time: <br />Corporato Offloos & Laboratory <br />Offloo & Laboratory <br />Office & Laboratory <br />Offico & Laboratory <br />Office & Laboratory <br />853 Corporation Street <br />2500 Stagecoach Road <br />563 E. Undo Avenue <br />3442 Empresa Drive, Suite 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: (605)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)5254172 / Ag FAX: (805)392-2063 <br />FAX: (209)942-0423 <br />FAX: (530)343-3807 <br />FAX: (805)783-2912 <br />FAX: (559)7348435 <br />CA FLAP 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 />