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D <br /> 2795 2nd Street, Suite 300 <br /> C. AffK7C4LALC. <br /> Davis,CA 95616Lab: 530.297.4800 <br /> Fax- 530.297.4808 Lab No. 3� Paye / of <br /> Project Contact(Hardcopy or PDF to): EDF Report? ®Yes ❑No a <br /> John Smith Chain-o#-Custody Record and Analysis Request <br /> Company/Address: Recommended but not rmndatory to complete this seeWw <br /> Delta Env. Sampling Company Log Coda: Q <br /> DEIO Analysis Request <br /> Phone No.: FAX No.: Global ID: T060770464 <br /> LO X <br /> 638-2085 638-8385 <br /> Project Number: P.O.No.: EDF Deliverable to(Email Address): � � � in 3 <br /> jsmith@deltsenv.com � 11 6y� w v <br /> N N O .a <br /> Project Name:Tesoro-Lodi Project Address: $ T m m � a � <br /> Lodi W Ln s� &I W g I o _ w L m <br /> m <br /> SamnlPr RinnaTurp fhPlnw1: <br /> Project Address: Sampling Container Preservad Imatrix y 0 ti ' N p <br /> Q g C } = N U. <br /> w ,n W W J 1 m m N <br /> E W U z w p ¢ a W x x x o o v M a R t <br /> m le Desi nation Date Time to z s U z to m ►�- h w r <br /> qI I I XI y ly I Yi �dl <br /> w = az <br /> r ` <br /> Relinquished by: Date Time Received by: Remarks: <br /> Relinquished <br />� <br /> Relinquished b : Date Time R d b L <br /> q Y y ry: Bill to: <br /> � 4 103-3 ��x D <br /> DJsWbWion: While-Le6, Pink.Odginalor - Formslcoc 121 Da1.lh9 <br />