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Dav <br /> KI FF H Lab: 530.297.4800 Street, 1�0 SRG#I Lab No. (�L� l l Page _ of <br /> Arialytkat Fax: 530.297.4802 <br /> Project C me (Hardcopy or PDF To): California EDF Report? 0 Yes a Chain-of-Custody Record and Analysis Request <br /> > . 'I <br /> Company/Address: Sampling Company Log Cade: Analysis Request TAT <br /> Phone Number Global ID: <br /> {ji 12 hr <br /> Fax Number: EDF Deliverable To(Email Address): m = <br /> Project M P.O.#: Bill to: w n $ 24❑hr <br /> 7;1% 7`f W1 a 3 a m m <br /> F W <br /> Project Name: Sampler Print Name: w = w g a <br /> Fd m m o ❑ n <br /> Samplernalure: r Q W w 481,r t< <br /> Samlin Container Preservative Project Address: matrixw EY <br /> w cCt' ..,rt ❑ <br /> 72hr <br /> w <br /> O o C m i m o 111 y m <br /> Q am C S O O f m m J <br /> > i@ m eo m X (vCy m m a m m — 8 r F O hl <br /> o al o = v U 2 0 'o = 0 0 a a a o x x f ; P o w H 1 Wk <br /> Sample Designation Dale Time a 1n a (7 r x x z 3 m ¢ f m n > > > cai 3 J <br /> 73 .tt,-1 I;Is7oi IzzS jI I I XI I I-VI I I I <br /> 13 -C-E li <br /> -4 I-Z ' <br /> O <br /> CA <br /> JTL <br /> Relinquished by: Date Time Received by Remarks: <br /> 61 6: 1lWorl 1245 �11-4Cow jos,-kc 04 s <br /> Relinquished brDate Time Received by <br /> Relinquished by: Date Time Received by Laboratory: ^l1,--1y,t�"�y'�l,/� For Lab Use Only: Sample Receipt <br /> -- Q1� jZ � I T Temp°C ImbalsDale . lime Them,lDe caabm wezmr <br /> V/i" �• (N1Iy Oil(xf� (ZcV Yes I No <br /> Duh tion. WNte-Lab:Pink-Odainata <br /> Rev: 001708 <br />