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wwyv.fglinc. com <br />TEST DESCRIPTION AND ANALYSES REQUESTED <br />Phone: <br />Quote Number: <br />Smnp!er(s):e£Sampling Fee:Pickup Fee: <br />1 <br />L U7 <br />Remarks Time: <br />Time: <br />il^ <br />£■ <br />a <br />Z <br />i <br />CHAIN OF CUSTODY <br />AND ANALYSIS REQUEST DOCUMENT <br />C6en<: Michele Jacobs <br />Customer Number: 3019285 <br />Address: 19818 N. Ripon Rd <br />Ripon, CA 95366 <br />Fax: <br />michelejj928@gmail.com <br />Michele Jacobs <br />Ofrtoo & Laboratory <br />2500 Stogocoach Road <br />Stockton. CA B5215 <br />TEL: (209)M2-O1B2 <br />CA ELAP Certification No. 1503 <br />Samp <br />Num <br />a <br />I <br />1 <br />§ <br />1I <br />1 <br />I <br />l <br />I <br />$I <br />1 <br />o 1 <br />I <br />oI <br />1 <br />5 <br />Lab Number: <br />•3 <br />I s <br />8I <br />S. <br />! <br />■S <br />e £ <br />! <br />o <br />i z <br />I <br />i <br />1I <br />I I I <br />■aJ <br />Tane <br />Sampled <br />Hop <br />Date <br />Sampled <br />^50 <br />(209)481-7555 <br />Email Address: <br />Contact Person: <br />Project Name: <br />Purchase Order Number: <br />Rush Analysis: | | 5 Day | | 4 Day | 13 Day | | 2 Day | | 24 hour <br />Rush pre-approvaJ by lab (initah): <br />Electronic Data Transfer: No Stale | [Client Other:. <br />Corpora to Offlooa A Laboratory <br />853 Corporation Street <br />Santa Paula. CA B3060 <br />TEL: (805)392-2000 <br />CA ELAP Certification No. 1573 <br />li <br />If fi <br />h <br />II H <br />h <br />at <br />I 3 <br />it <br />li <br />RelinquiahaL Date: <br />TP lAtO <br />Received BvQ Date: <br />r <br />Offlca & Laboratory <br />3442 Empresa Drivo, Suito D <br />San Luia Obispo, CA 93401 <br />TEL: (805)783-2940 <br />CA ELAP Cortfrcation No. 2775 <br />ElWIROWiEKTAL ' AGRICULTURAL <br />AiKilytical CliuiuisU <br />Relinquished . Date: Time: <br />M 0^liw IM <br />me: Received By: Date: Time: <br />km <br />iry 'T Offlco & Laboratory <br />ro. Suito D 9411 W. Goshen Avonuo <br />Vian!In. CA 93291 <br />TEL: (559)734-9473 <br />CA ELAP Codification No. 2810 <br />Compositor Setup Date:Time: <br />Location Description <br />RebnquTheti Dale: r Time: <br />n <br />Received D«l«: Time: <br />Offloo a Laboratory <br />563 E. Undo Avonuo <br />Chico. CA 95928 <br />TEL: (530)343-5818 <br />CA ELAP Codification No. 2870