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West Analytical Laboratory Phone# 530-757-0920 CHAIN-0F-CUSTODY RECORD AND ANALYSIS REQUEST <br /> a d,vfr,on of nq, 13"M, <br /> 1046 Olive Drive, Suite 2, Davis, CA 95616 Fax# 530-753-6091 — <br /> Project Manager Phone# <br /> 9 ANALYSIS REQUEST a0 7171 Lab <br /> _ Use <br /> Cormp1anylAddress F�A7Xsy ([�1�p Zgl' S� 2 C� / / �'�`"-� � ONLY <br /> Vllc�nr+L1t4� F0 NC, C3� �Gl+++tKJ,/. 1[l .r� 5 L � Z3(o ✓i rnu � <br /> Project Number P O# Project Name <br /> lz51 $Z i`1l 5�k�L_ ' <br /> Project Location Sampler Signpture N <br /> _ 1� E <br /> �'EOC1C�p�l v` / ✓��r/�% �w7 �' co m rmi S <br /> Container Method s — a H N z <br /> Sampling Matnx N �; ° o N W <br /> (7ypelAmaurrt) Preserved $ 4Iq r- c)o <br /> Sample ID p � �, � oa <br /> Q t� O Z I X ,9 LD co m cD p U "1 f+ o <br /> DATE TIME `Uz Lu p QO aaaa ¢ u� w ~ L <br /> jr t? z ova mmrrwu� wwLuo � v <br /> 4114A2i� 0gSs X x <br /> a2 <br /> t z al�r4 f o 00 <br /> X <br /> iL <br /> g_,-V ►a D i X o� <br /> 3� Ip OS <br /> pl 35 <br /> - r lifts f xx �r; <br /> 4° �l/G �s 120 1 x x X <br /> P14 - 1 50 L r�a� X x x <br /> Relinquished by Date Time Received by Remarks <br /> P-0 y 14-0 <br /> Relinquished by DateTime Received by <br /> ____ ------ ``— J -- -- ---- --_ —_ ---- <br /> Relinquished by Date Time Received by Laboratory Bill To T Etvf�S. s C`."�'`'n y <br /> S"V0k(< To <br />