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Davis, <br /> Suite 300 <br /> Lab: <br /> CA St18 <br /> reet, <br /> bs53027.800SRG# Lab No. Page _ of <br /> Fax: 530.287.4802 <br /> Projed Conta`t(Hardcopy or PDF To): California EDF Report? ❑ye, 110 <br /> �� � Chain-of-Custody Record and Analysis Request <br /> Company/Address: Sampling Company Log Code: Analysis Request TAT <br /> W II¢rG - ✓NI S,i O( rVi'aS PLEASE CIRCLE 11Phone Number: Global ID: METHOD72 hr <br /> 71L ? _ tiiH <br /> Fax Number: EDF Deliverable To(Email Address). m = <br /> o y <br /> < w o ❑ <br /> Project#: P.O.#: Bill to: w < N 3` $ 24 hr p <br /> Li <br /> ry w <br /> Project Name: Sampler Print Name: m w <br /> :� m m = w ❑ m <br /> r m W 2 0 N Q � m n o 48hr J <br /> jr L,, ) <br /> Sampler�Si-g�nr�ature: o w = W w w C! <br /> S�C " vN 1I�OLVtU?1,,Lt, m WQ d 'm uN r m o (L o m <br /> +Project Address: Container Preservative Matrix w <br /> (w3n <br /> El <br /> W w 7Lr72q�h <br /> .� <br /> tr <br /> O m aQ <br /> rl fw¢ <br /> E a = x wk <br /> M 0 ° & vSample Designation Date Time m a 0 s Z > i- <br /> P -� 1 Al <br /> C ' I - IS <br /> V\ <br /> rt' � 1ti i Old <br /> 0(a <br /> Ee 5 - sys I <br /> Reiinq had by: Date Time Received by: Remarks <br /> //a 12 . <br /> Relinquished by. Date Time Received 6 : <br /> Relinquished by: Date Time R7 by aboratory For Lab Use Only. Sample Receipt <br /> G��, „rr l Temp'C - Initials Date Tine Therm.IDk cod.mP�nc <br /> No <br /> Distribution: Nfine-Lab;Pink-Originator Cl <br /> Rev: 061706 <br />