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ENVIRONMENTAL CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> Lab Number: TEST DESCRIPTION AND ANALYSES REQUESTED <br /> Client: Live Oak GeoEnv ironmental <br /> Customer Number: 3016608RIf <br /> Address: 407 W.Oak St. <br /> 3 3 E <br /> 1 Lodi, CA 96240 <br /> Phone: (209)369-0375 Fax: <br /> LrmailAddress: abby@logelodi.com � I <br /> Contact Person: Abby Racco <br /> i Project Name: Ferreira, 1153 S. Golden Gate,Stockton it <br /> !Purchase Order Number. <br /> c� <br /> Quote Number: <br /> 1 sampler(s): n ' Q } 9 U� €� •N O E � i s E 1 ( 4 3 <br /> h aAz' a b <br /> { 4:Z) i # 4 <br /> Sampling Fee: Pickup Fee: /l 1 o ° z z: 1n ` ' I <br /> a m 'uJ m i !a <br /> Compositor Setup Date: Time: z <br /> 0 <br /> Location Dcscriplioa Date Time <br /> Sampled ovma, ,s( ��!J3 ,l <br /> q <br /> e 1 <br /> -- 1— <br /> i 1 Domestic Well 1 �.•? � G a 4 P/GI p i DW l SRC_O+ _ X X <br /> LL <br /> ._I . <br /> ...,,.,,...., _ k <br /> --A <br /> .......... -– <br /> Remarks Rer. 1 Datc:��T ��. Relinquished /Data Time: R���ed 7 /� L3 Time: <br /> / 2 <br /> `f �2 3 t7 / J / 1 <br /> Re y: Date: Time:/� Received By. ate: Time: ReccivedBy: Date: Time. <br /> Corporate Offices S Laboratory Office&Laboratory Office S Laboratory Field Office <br /> 853 Corporetlon Street 2500 Stagecoach Road 563 E.Undo Avenue Visalia,Callfomla <br /> Santa Paula,CA03060 Stockton,CA 95215 Chloe,CA 95926 <br /> TEL:559!734-9473 <br /> TEL:8051392-2000 TEL:209/942-0182 TEL:53013435818 Moblle:5591737-2399 <br /> FAX:8051525.4172 FAX 2091942-0423 FAX 5301343.3807 FAX:5591734-8435 <br /> CA NELAP Certification No.01110CA CA ELAP Certification No.1563 CA ELAP Certification No.2670 <br /> 1�� <br />