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vDais?CA gt5�616 <br /> K1FF uite 300 -7 <br /> Ana! lcal LEC Lab: 530.297.4600 SRG#!Lab No. u +C/ Page 1 of 1 <br /> Fax: 530.297,4802 <br /> Project Contact(Hardcopy or PDF To): California EDF Report? ❑yes ❑No Chain-of-Custody Record and Analysis Request <br /> R.Smith <br /> Company 1 Address: Sampling Company Log Code: Analysis Request TAT <br /> Horizon Environmental Inc. HEIE <br /> Phone#: Fax#; Global ID: <br /> 916 939-2170 916 939-2172 70607799505 � 12 hr <br /> Project M P.O.#: EDF Deliverable To(Email Address): W n ❑ O <br /> 1792.04 WO 202869 - °' m <br /> o m ¢ a 24 hr <br /> Project Name: Sampler Signature: Emil D. Kruck w o w N <br /> Abdelwahed Fac WD a w m m N a <br /> H N ElJm <br /> o o D <br /> a <br /> IL <br /> Project Address: samplingContainer Preservative Matrix n m m a --, w ¢ w o 46hr <br /> ILL <br /> 2255 South Airport Way w W o a a ❑ <br /> N � <br /> Stockton Q ¢ 4 2 w w m ° rn m o W m 72 hr <br /> O p a a w c 2 S O d o To o <br /> 7 y N Iwly7 W W 3 O1 ao Lo N 0Y Q1 T J H <br /> of 2 p U Z o 6� co o m F a. O O% m m ro 2 2 w 0 <br /> Sample Designation Date Time v rn (L (9 12 z x z rn 4 1 1 m P to r- 1 > > > 9 <br /> SP A,8,13,D) . ',30 41 1 1 XIX x X1 x I I I I X1 I x Joy <br /> C <br /> Re quished by: Emil D.Kruck Date Time x Remarks: Standard TAT <br /> 1 1012.4113 1004 <br /> Relin wished by: Date Time Received by: <br /> Bill to: Ultramar, Roger Levin <br /> v Relinquished by: Date Time RFTemp*C <br /> ed by Laboratory: For Lab Use Only: Sample Receipt <br /> m <br /> rn Initials Date Time Therm.1D# codara ae3em <br /> Yes ! No <br /> Co Distribution:While-Lab;Pink-Originator <br /> Rev: 051 805 <br />