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SallOS 'SIN3V/103S 'S53.1.1/M 09Z6-698-60Z Relinquished by IWell [ Sample Identification Purveyor !Field Sampler - Printed Name & Signature: Email Address: Email Address: labgenvironmental com homestead•oods209 • 'mail, corn rhone(Fax: Cell phone number: 209-869-9260 209-573-3259 !Address: Address: 2603 Patterson Road, Suite #9 20700 S. Murphy Rd Riverbank CA 95367 Ripon. Ca Attn: Darrell Martin !Kristin Bruns 'Company: 'Company: Environmental .corn LLC Homestead Goods Report to NJ <br />R3 cn Date Cl, cl) <br />3 <br />-cs EDC (OTO) Client Info: t. <br />? Received by 0630 -i _. <br />3 co <br />5. <br />4.12 <br />x Sterile bacti Container & Matrix Project Information Plastic Number: )ject No: Dject ID: Water Quality 5 Glass_ <br />Unpreserved <br />x Preserved <br />Wastewater <br />x Drinking Water <br />Soil <br />__Z.- <br />_._ <br />.„4 <br />-,......2„, <br />------:-.._ I Date I <br />, Other <br />Total Number of Containers per Sample ID Signature below authorizes work under terms stated on reverse side. x BALPA Analysis Request <br />_ <br />Cg.k <br />-.... <br />C. <br />v;-• C.' , 0 <br />Nitrate as N <br />..1 <br /> Travel and Silo Time CA Geotracker EDF Report? 0 Yes 0 No Global ID Sampling Company Log Code EDF to (Email Address) 0 DOW Write On EDT Transmission? 0 Yes No State System Number: NON EDT If "Y" please enter the Source Number(s) in the column above Mileage l'aid _55.00 by CC I Notes / DDW Source Codes I <br />-o <br />07 "a <br />E -0 <br />,3 a o. < 0.1 _ <br />.t, <br />0 °3 '''' Xi -4- 7 0- C = cu cn a -T, c -4 z co • • (7„ 4f. •• ...< .., Standard 5 days 0 TAT , <br />.,,-, <br />-7; rCarlsbad <br />'V rt4 <br />9,- <br />3 0 Elk Grove Livermore I • ir <br />rd = TEMP °C I