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GL <br />VU )rir1f.7,1A1 AtiRICIIITURAL www.fglinc.coin CHAIN OF CUSTODY <br />AND ANALYSIS REQUEST DOCUMENT <br />oicni: Mike Wutzke <br />Custer= Number: 3019150 )4/, <br />Address: 21600 N. Kennefick Road <br />Acampo, CA 95220 <br />phone (209)642-5659 Fax <br />Email Address. mike@diamondtruckbody.com <br />Contact Pca son: Mike Wutzke <br />Pilaw Name 21600 N. Kennefick Rd. Acampo CA <br />Purchase Order Number: <br />Quote Number. <br /> <br />L.ab Number: <br />507-/ 8 TEST DESCRIPTION AND ANALYSES REQUESTED Method of Sampling: Composite (C) Grab (G) V 0 .6 <br />1 0 <br />15 <br />I Z Type of Containers: (0)0lass (P)Plasbc (V)VOA (MT)Matal Tube V <br />a.- <br />Z <br />• <br />1 <br />g z <br />i.... . <br />1 <br />••••••ftiaar (SW) Surface Water NW) Montan/1g Well (OW) Oround Water (TM Travel Blank (WW) Wavle Water (OW) Drinking Water (3) SoIl (SLO) Sludge ISLD) Sate (0) ON E <br />g 1 . <br />ei <br />i <br />A' <br />4-: .... <br />1 <br />I <br />b <br />1 <br />6 <br />t <br />S <br />g <br />g <br />§ --- <br />A' Iom Leal Ilesue (PET) Petiole Tissue (PRO) Produce 2 <br />i G E fig <br />4-7,- <br />h — .... .......a. <br />i - <br />II <br />ii. <br />a Z . <br />'t <br />in tk <br />Rush Analyso: 5 Day 4 Day I1 Ihty 2 Da). 24 hour ' <br />Rle.h pre-app oral by Lb lethal:). <br />Electronic Dam Traricrei . No State [II(ltent Other <br />sampicos). ,- <br />11 Sampling Fee P kup et' <br />Compositor Setup Date Time __\1._ <br />Sump <br />Num <br />Location INscription Date <br />pi!, <br />Time <br />Sampled <br />Well 1(41::# 106 G OW SRC 0 1 1 <br />- <br />Remarks 1 R i• Wier' 7 Date: Time. <br />_1 <br />Relin - hod Dal/ lune. <br />1//410 t1r0 <br /> <br />Relinquished Date: Time <br /> <br />(its. --7 /75/29 13 -z1 <br />Date:j Tine. <br />IlAilbil . ' 1 <br />Receilmtt Fly i Date f Time <br />6)L'o." 711141Pi- 1-107) - <br /> <br />Receired fly- Dale Tulle <br />r7___ ,.._. . _ <br />, L. <br />Corporals Offlorta 8. Laboratory <br />853 Corporation Street <br />Santa Paula, CA 93060 <br />TEL: (805)392-2000 <br />CA ELAP Certhustion No. 1573 <br />Office & Laboratory <br />2500 Stagecoach Road <br />Stockton, CA 95215 <br />TEL (209)942-0182 <br />CA ELAP Certification No. 1563 <br />Office & Laboratory <br />563 E. Undo Avenue <br />Chico. CA 95926 <br />TEL: (530)343-6818 <br />CA ELAP Codification No. 2870 <br />Office & Laboratory <br />3442 Emmert Drive, Suite D <br />San Luis ()Napo, CA 03401 <br />TEL: (805)783-2940 <br />CA ELAP Certification No. 2775 <br />Office & Laboratory <br />9411 W. Goshen Avenue <br />Visalia, CA 93291 <br />TEL: (559)734-9473 <br />CA ELAP Certification No. 2810