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CHMN OF CUSTODY <br /> Special www.fglinc.com <br /> Analytical Chemists Laboratory Copy (1 of 3) <br /> II <br /> 35731:08/02/202l TEST DESCRIPTION Sce Reverse side'l'or Container. Preservative and Smni line in(orm;uion <br /> liens: San.loaquin CountiLill) <br /> Nddress: San Jooquin Co.Environmental I lealth Dep <br /> Water Quality Division — <br /> Attn: Michael Kith °' <br /> 1868 East Hazelton Ave. <br /> Stockton,CA 95205 5 b <br /> c. <br /> ?hone: (209)468-3444 Fax: w x <br /> �omact Person: Michael Kith ! <br /> Project Name: �6—y(61tizeLo ;) <br /> x s <br /> Purchase Order Number: tiw v v G <br /> ' : x o <br /> �uotc Number: LU = n <br /> U <br /> L[] u W <br /> Sampler(s) VI <br /> i A <br /> Ln <br /> Sampling Fee: Pickup Fee: <br /> Compositor Setup Date: / /_ Time: <br /> -- v E yr u <br /> Lab Numher: STK �"t 3-17910 _ a A j <br /> ;amp Date I'inu o — J E <br /> Num Location Description Sampled Sampled F= V) T <br /> Remark,: Relinquished Dane: Time: Relinquiss d Date: Time: Relinquished Datc: 1-imc: <br /> Ate e�Zz �� s/qz-o I-10D <br /> Received By, Date: Time: Receive By: Date: "Time: Rccci%ed ll\- I>ar : Timc: <br /> 2Z Ib55 tS Vi ZZ 17J <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 9415 W.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 <br />