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KIFF 2795 2nd Street,Suite 300 <br /> Davis,CA 95618 /�C� 1� g — — <br /> Anai Lica!titsO Lab: 530.297,4800 SRG#1 Lab No. �j( Pae of <br /> y Fax: 530.297.4802 <br /> Project Conta (Hardcopy or PDF To): California EDF Report? ElYes ETNo <br /> Chain-o#-Custody Record and Analysis Request <br /> Company 1 Address: Sampling Company Log Code: Analysis Request TAT <br /> y ',(C- r J 1 0C r (4- ,P) PLEASE CIRCLE ❑ <br /> Phone Number: Global ID: METHOD <br /> 12 hr <br /> Fax Number: EDF Deliverable To(Email Address): o <br /> R N m ❑ l <br /> Project#: P.O.#: Bill to: A w a N 24 hr 0 <br /> %v"A Co <br /> < g w <br /> w a o a <br /> ??i 4 0"1 1 <br /> N <br /> Project Name: Sampler Print Name: p w m �, w ❑ ma <br /> CGt7+^I 3 Kr ~Ld p m ¢ v m h `� '�7 48hr <br /> r74m /�--Fc� f:�tP*�M�%� Sampler Signature: W w =O UJ Q w N N o ti o a rJ li <br /> - r Co w a u, Lo co ao Z `O Sty Oa <br /> w ay uJ o ry ' <br /> Project Address: <br /> Sampling Container Preservative Matrix o s + ¢ N - a 90 a ¢ .- o - ❑ <br /> O N uJ O L) N N W W W U N ' 2 7Zhr <br /> (.,} ap m l[) U U 0 d v <br /> ;-�n ,n ro a m N o m mQ �m n4. Wolo <br /> O o d m m > 2 O O r W m — <br /> W <br /> > ; .1 m m m w <br /> E m y w O = $1O' — m w x F W :� m _ a; W _� 1 Wk <br /> 2 0 'o F I- o- o O m o 0 o d a Q m o .a M <br /> Sample Designation Date Time v U) o C7 NXIM: z to a m > > > <br /> 1-3 -w-t <br /> ;'3 <br /> f _U CA <br /> Relinquished by: Date TimeReceived by: Remarks: <br /> Relinquished b% Date Time Received by: <br /> Relinquished by: Date Time Received by Laboratory For Lab Use Only: Sample Receipt <br /> ri 1 /j��j temp°C Initialsr 1Date Time Therm.ID 9 coolant Present <br /> O`l iZ 1 \ �� 1.�� 0�[ � l � Yes ! No <br /> Distribution: White-Lab;Pink-Originator <br /> Rev: 061706 <br />