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'i <br /> 2795 2nd Slree%Suite 300 <br /> /FF Davis,CA 95616 <br /> Lab: 530.297.4800 <br /> ANALYTICAL LLC Fax: 530,297,4808 Lab No. Page a1 <br /> [Prni <br /> ject Contact f Hardcopy or PDF To): California FDF.Report� Yes ❑No <br /> Cke e o� Chain-of-Custody Record and Analysis Request <br /> 1-7 <br /> mpany/Address: �, 1/, PACMM I*dbutnet � ft <br /> 1,4 JD�� e- 9s - Sampling Company Log Code:!I 37 6_ �d Analysis Requestne No.: FAXo [3 ba!ID: x UJ <br /> ect Numbe . P.O-No: EDF Deliverable To(Email Address): % M m <br /> O id h <br /> o ut w w x C <br /> Project Name: Sa ler Signature ' m m Q 4 C <br /> rW .^n o mW tag M p�p ° S <br /> o F C7 4] m t0 a �_ us N <br /> Project Address: Sampling <br /> � - a 0° J N M <br /> Gc1e� Pt 9 a_Container Pro ative Matrix _ m w. .tom .. . N., Y <br /> Jr I O V M R L - U. <br /> v <br /> IOLW-W>JT <br /> i!JW °" [7 �; ro4 Z f XSam le Desi nation Date Al <br /> Tirna v = z u ? a o a ax a o o ° a 4 _` <br /> rn m m r r- w <br /> X <br /> 2-AW <br /> 9SG a <br /> 03 <br /> co <br /> Relinquished by <br /> NR,lr,i : Date rime Received by: Remarks: <br /> fished by: Date Time Received by: <br /> Relinquished by: Date T Recei b ratory: Bill to: <br /> 4°b7�4 ALOI t 4e4111i <br /> Distribution: White-Lab, Yellow-File,Pink-Originator <br /> Forrnslcoc 121001A0 <br />