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CHAIN OF CUSTODY <br /> ENVIRONMENTAL AND ANALYSIS REQUEST DOCUMENT <br /> Lab Number- TEST DESCRIPTION AND ANALYSES REQUESTED <br /> -- - - <br /> Client: Live Oak GeoEnvironmental <br /> Customer Number: 3016608 i <br /> Address: 407 W. Oak St. <br /> Lodi, CA 96240 1 i <br /> Phone: (209)369-0375 Fax: <br /> Email Address: abby@logelodi.com 8 a i P <br /> C <br /> 1� I <br /> Contact Person: Abby Racco m o� $ <br /> RU <br /> Project Name: Rivera, 22120/22124 E. Butler Ln., Linden CA ro a of E <br /> Purchase Order Number: <br /> Quote Number. Q @ o m s <br /> p � Q F <br /> Sampler(s): �W F\ � U m c> a a <br /> Pe, J N <br /> oy d d c �� Nm ' Qc� s <br /> o <br /> Sampling Fee: Pickup Fee: s ' gym <br /> J I p i P 7 <br /> Compositor Setup Date: Time: { 8 = c a: v <br /> m �vl <br /> �L ! .C J fV <br /> f o o w N rn En <br /> t _ <br /> I <br /> k 1 <br /> Sttmp Location Description Date Time <br /> Sampled z' w a� .m A. <br /> t <br /> i Nun �mp'ed <br /> �u1�i�r <br /> 1 Domestic Well 2 2 ista 115 G 4 P/G P DW SRC O X X <br /> t <br /> e <br /> F 1 7 <br /> j <br /> h � I <br /> ...,..:._. ... ., r..... ' .. ., a —mr-- ._. • vn a _... ., .... :: — .,•- .... <br /> i <br /> �.... I A.. 1 I. <br /> ; <br /> Remarks Relin wished Date: Time: Relinquished Date: Time: Re inquished Date: Ti 11 me: <br /> 62 ,- kC- �Ih� ��� l <br /> Received By: Date: Time: 5pyed By: Date: Time: Re 'v By: Date: Time: <br /> bc <br /> Corporate Offices eboratory, O is &Laboratory Office&Laboratory <br /> 853 Corporation Street 25 Stagecoach Road 563 E.LindoAvenue Visalia,California <br /> Santa Paula,CA 93060 Stockton,CA 95215 Chico,CA 95926 TEL:559r734-9473 <br /> TEL:805/392-2000 TEL:209/942-0182 TEL:530/343-5818 Mobile:559/737-2399 <br /> n FAX:805/525-4172 FAX:209/942-0423 FAX:530/343-3807 FAX:559/734-8435 <br /> `� , CA NELAP Certification No.01110CA CA ELAP Certification No.1563 CA ELAP Certification No.2670 <br />