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i <br /> 2795 2nd Street,Suite 300 4P 41 <br /> KKI� 0 Davis,CA 95616 -- - rr <br /> Lab: 530.297.4800 SRG#/Lab No. Page of 1' <br /> /gl]c�j�/tlCal LLC pax: 530.297.4802 <br /> Project Contact(Hardc py or PDF To): Califomia EDF Report? yes []No Chain-of-Custody Record and Analysis Request <br /> Company/Address: Sampling Company Log Code: Analysis Request TAT <br /> pm� P76 NLa <br /> Phone#: Fax#: Global ID: o El <br /> t-1 7,7k I I quo &3t-1325: LM 12 hr <br /> Project#: P.O.#: EDF Deliverable To(Email Address): � a 0 �' ❑ p <br /> r 00 7 w m P 24 hr S <br /> Project Name: t $ o CD na. <br /> Sar <br /> � (0?0 °° <br /> e lin V W � m O w Qd N LA m ❑ <br /> ProjLL <br /> �elct Addreesss:} �/�-may,, yip Sam lin Container Preservative Matrix $ � m � co �n w � a o a o 48 hr o` <br /> � co <br /> w wLU <br /> Q a 4 a W > a 72 r <br /> W w <br /> 1= m T u Q m LU W X C3` Di 3 m m F L <br /> p m o `� U Z o H a 0 0 a o o a S W IIl6Al <br /> Sam le Designation Date Time a i 7 t- t z z tR "¢ m i- ,n n > > > i- 3 1 wk <br /> es 5 x XI I Ix A X. I IY-1 lei- <br /> �J <br /> Y1r1 w <br /> i <br /> Relinquished by: Date Time Received by: Remarks: <br /> � 1s la.sD <br /> A�\ Ed rN -„ (d <br /> Relinquished by: Date Time Received by: <br /> ------------------------------------------- <br /> Bill to: <br /> Relinquished by: Date y TimeRecei by ratory: For Lab Use Only: Sample Receipt <br /> ./� <br /> l� f Temp°C Initials Date Time Therm.ID#I coolant PM604 <br /> ! No <br /> Distribution: White-Lab;Pink-Originator <br /> Rev: 051805 <br />