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i <br /> 2795 2nd Street, <br /> KI FO Da vis CA 0 297, Page of <br /> 480p1te 300 SRG#/Lab No i — — <br /> Analytical Fax: 530.297.4802 r�1� <br /> Project Conta t(Hardcopy or PDF To): Canfomia EDF Report El Yes R'No Chain-of-Custody Record and Analysis Request <br /> Company/Address: Sampling Company Log Code: Analysis RequeslTAT <br /> �• 4flUrb <br /> a -K✓41 Sfac r ut e5 PL MMOD CIM� ❑ <br /> Phone Number: Global ID: 12 hr <br /> Vj » - ) HH <br /> Fax Number. EDF Deliverable To(Email Address): <br /> w ❑ <br /> Project#'. P.O.#: Bill to: 11 a a m ) 24 hr <br /> 7 3,4.0`I <br /> Project Name: Sampler Print Name: m w 0 <br /> Ctf K Ji °� m a .^oo 48hr <br /> Sampler Signature: w 8 W a w <br /> Project Address: Sampling Container Preservative Matrix w m o 7❑2hr <br /> 0 m m r a y <br /> 8(7 b C 'l rV a � <br /> d f <br /> 4dwm wo <br /> Cr <br /> or <br /> > >. m c mwL " e w 1 w <br /> k <br /> E aO Q2 — <br /> o ¢ <br /> > <br /> Sample Designation Date Time e i55 x z n m > <br /> 3 <br /> Edi "2 X i,, k 0\ <br /> I't I OZ <br /> Iy t7 I ° <br /> ri <br /> 6' <br /> Olo <br /> Ee i — 5�s <br /> Relin had by: Date Time Received by: Remarks: <br /> M1/�V0 12 - <br /> Relinquished by Date Time Received b <br /> Relinquished by: Date Time Rem by aboratory ' For Lab Use Only: Sample Receipt <br /> ��� � -S ePaC Initials Date Time Therm.IDk �+t aesem <br /> n F) I es No <br /> Diaalbu : white-Leb.Pink-Ongnelm <br /> Rev: 1101708 <br />