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2795 2nd Street,Suite 300 <br /> .�� Davis,a : <br /> L530.297.4800 <br /> ANALYTICAL ccc Fax: 530.297.4$08 Lab No.3e 04C5 Page of <br /> Project c ntact(Hardcopy or PDF To): California EDF Report? Yes ❑No <br /> � Chain-of-Custody Record and Analysis Request <br /> CO any/Address: Reconrnendedlxdriot ma b loco etethls9eefbn: <br /> �/p�Rr �� sampling company tog coda: Analysis Request r <br /> a <br /> Phone No.: FAX No.: Global M: m K <br /> CM Ld <br /> Project Number: P.O.No: EDF Deliverable To(Email Address): 9 S S m m <br /> ?J�3- ,�- o X CN <br /> Project Name: [f fy � Sampler Sig t m m m Q m <br /> �t G✓' o mgg m < _ och <br /> W N U m c C4 � <br /> Project Address- CL nx. <br /> J Sampling on er Preservative Matrixm _ o <~ M " �, N 131 <br /> o x a m c } o 04 U. <br /> ap <br /> O Z �'rn � <br /> E x z x �c R` �c a <br /> Sample Designation Date Time 0 (n _ _ z c°n a ° ° ° ° w <br /> .az -- 3r� i i <br /> a3 / - <br /> A/ - - <br /> J v7 <br /> Relinqui hed by: Da Time Received by. Remarks: <br /> I � <br /> Retro hed b . D e Time Received by: <br /> I <br /> linquished by: Date Time Received by Laboratory: Bill to: <br /> i <br /> Distribution: Where•Lab, Pink-Originator Forms/cm 1210D1.Ih9 <br />