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1 279 Davis, Street Suite 300 <br /> Anal <br /> KI tFF Fax: 530 25616 <br /> 530.297.97.48024800 <br /> 748 02 SRG#/Lab No. T-5-103 Page 1 of 1 <br /> Project Contact(Hardcopy or PDF To): California EDF Report? ❑Yes No Chain-of-Custody Record and Analysis Request <br /> Jennifer Worsley <br /> Company I Address:Apex Envirotech, Inc. Sampling Company Log Code: Analysis Request TAT <br /> 11244 Pyrites Wy., Gold River,CA a _ ❑ <br /> Phone#: Fax#: Global ID: <br /> 916-851-0174 916-851-0177 m 3 12 hr T <br /> Project#: P.O.#: EDF Deliverable To(Email Address): m a N ❑ O <br /> DLT02.041 wo 0p € 24 hr m <br /> m a ❑ u <br /> Project Name: Sampler Signature: <br /> Tracy High School w o o �_ a o _ ❑ <br /> Project Address: Sampling Container Preservative Matrix a g w � m w � a a w � 48hr u`o• <br /> m a a ¢ LL w. d o U <br /> 315 E. 11th Street,Tracy o 0 o m w w o i ¢ <br /> Q a ¢ m w a 'm i W a a m o 9 m 72 hr <br /> O w w, w m a`> m i4 2 O O o u <br /> J <br /> p Field Point > w 9 c �' — m m x T v m @ M x w d <br /> Sample Designation E m 0 O S <br /> Name Date Time o w Q- c7 12 , x x z i ce ¢ M 2 m - > >° > r 3 G 1 U 1 wk <br /> -TF-w-1 i G/0-7 2 I V x x >� xI I <br /> TP- e -lZ 2:z3 I I I I OZ <br /> Tp-bar-k-12: 2 .30 1D� <br /> ° <br /> SP-I 2'45 � X b5 <br /> P-W0.�c(-12 2 NO <br /> B Z'L6 <br /> Relinquished by: Date Time Received by: Remarks: <br /> 0/0-7 �0 �a�Lie, 5P-IR t �P-16 = sP- I <br /> R quished by: Date Time Received by: heect U -3"4,Cr-""' J�lr +ke S <br /> Bill to: <br /> Relinquished by: — Date Time Received by Laboratory: • For Lab Use Only: Sample Receipt <br /> 031(00 �D3y Temp'C Initals Date Time Therm.ID cow�ra mem <br /> J / �L�y l� j . �o c% 6 !00 -S �L S e / No <br /> Disbibullon: White•tab;Copy-Originator /( <br /> Rev: 051805 <br />