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qqW <br /> 2795 2nd Street Suite 300 <br /> Davis,CA 95616 <br /> Lab 530 297 4800 Lab NoPage of <br /> ANALYTICAL ccc Fax 530 297 4808 <br /> Project Contact(Hardcopy or PDF To) Caiifornia EDF Report? ❑yes ❑No Chain-of-Custody Record and Analysis Request <br /> Jennifer Worsley i I <br />-- <br /> Company/Address R ecommended but not mandatory to complete this section Analysis Request Q <br /> Apex Envirotech Inc Sampling Company Log Code <br /> 11244 Pyrites Wy Gold River CA 95670 APEF <br /> Phone No Fax No Global ID o ❑ 12hr <br /> 916-851-0174 916-851-0177 T0607736979 n C 0 <br /> Prosect Number PO NoEDF Deliverable To(Email Address) _ m mo 24hr <br /> NWP01 004 _ rwestrup@apexenvirotech corn �' m o o <br /> � c <br /> m m w ❑ Q O <br /> Project Name Sampler C� �_, N v V N Q 48hr <br /> New West Petroleum Signature w o w ; as w O 0 <br /> C3 o co m t7 t7 0 0 ¢ �, u, ►. <br /> Project Address Sampling Container Preservative Matrix � Q a N N v =� ` N 72hr ` <br /> _ o <br /> p LU ILL V)�z t t a' m N :) 2rn Q o <br /> 6437 W Banner St,Lodi _ o M > @ - 1wk LL <br /> u, a n o 2 H c 8 z 0 0O <br /> Sample ' W r W W W x 0 o m]�. T 0, 009 0 W •#► <br /> 2wk <br /> Designation Date Time v in o ¢ z i v z m m ta- o w 0 <br /> CSA-31-1 I1-3�af 13,�* X X X I X I X I 1 1 wk `0` <br /> CSA-31-2 �— 1 pO5C X X X X X 1 wk _D <br /> Relin ulshed by Date Time Recelved by Remarks <br /> 7enip'C Tier IDd <br /> Inittel <br /> Re q shed by Date Time Received by Date "L , Two <br /> t qyi Coolant present (5) No <br /> inquished by Date Ti el Receiv by Laboratory Bill to <br /> due- <br /> r�.a <br />