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I <br /> KIFF 2795 2nd Street,Suite 300 <br /> Davis,CA 297.4 !2[� Pae of _ <br /> Lab: 530.297.4800 5RG#I Lab No. g <br /> 95618 <br /> Analytkal LZC Fax: 530.297.4802 — <br /> Project ntaGt(Hardcopy or PDF Co): California EDF Report? ❑r� �tuo Chain-of-Custody Record and Analysis Request <br /> Company I Address: Sampling Company Log Code: Analysis Request TAT <br /> , <br /> '- irfv.rC' —kvhl S C( 1'r, -� 5 PL ASECIR LE 11Phone Number: Global ID: 12 hr <br /> Fax Number: EDF Deliverable To(Email Address): o04 Z- <br /> = <br /> Project#: P.O.#: Bill to: w a N 3� °7 24 hr <br /> OD <br /> W ¢ to co N y <br /> Project Name: Sampler Print Name: o W r a s ❑ <br /> to m CO . w <br /> �+7 tC �; ~ 2 o w ¢ o w S 't 48hr J <br /> Sampler Signature: i w aD w LO „ J o <br /> co CD W Q �.: a N �_ m O LL <br /> W w <br /> 2 <br /> Project Address: Sampling Container Preservative Matrix + N ? <br /> U <br /> W 0 O LL U ¢laN <br /> J N <br /> 7❑2h <br /> r <br /> m U y N md(7 c <br /> Q <br /> imMx o° o° <br /> W m m p m 2 W .p RO O a 2 2 jm0o <br /> X o l n0Nm RN <br /> 2r <br /> 19 w FE nl O w R 1 w <br /> ko w °� . a=Sample Designation Date Time a 0z z ia m 0 <br /> a <br /> I mI l A. k iwk v'ik <br /> c <br /> Lk G <br /> i iy 70 11 00t' — Sys ! 07 <br /> Relinq hed by: Date Time Received by: Remarks: <br /> M <br /> 1//610 1z <br /> Relinquished by: Date Time Received b <br /> Relinquished by: Date Time Recei by aboratory: ( For Lab Use Only: Sample Receipt <br /> —�•�' 6f(; r ( Temp*C Initials Date Time �Thre�rm.ID# coaantPresent <br /> 6L(VA E) 1� es No <br /> Distribution: White-Lab;Pink-Originator <br /> Rev: 061708 <br />