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�r rir ■r ii■r r r i■is r ■■ r r rr r r iiia <br /> 720 Olive Drive, Suite D <br /> .�� Davis, CA 95616 i <br /> Lab 530 297 4800 <br /> ANALYTICAL LLC Fax 530 297 4803 Lab No Page of <br /> Project Manager Phone No <br /> -7o,!�- P-fi m GC 3 Sy 32 'F a Chain-of-Custody Record and Analysis Request <br /> Company/Address FAX No <br /> L�- 3 5 q Analysis Request <br /> Project Number PO No Email Address m x <br /> w <br /> ❑ pdf ❑ AS ❑ doc ❑otherN N m m <br /> Project Name Sampler Signature m o m O <br /> 6 00 <br /> 0 a C4 M m _ 4 F G1 <br /> my <br /> m m CO W O t N <br /> Project Location y / o) E C#A27-FJZ W G W 8 M o Q y N <br /> 2 � d = N Co Cl <br /> Preservative Matrix � o � � °� N <br /> Sampling Container m H o o <br /> Y 6a "p m W W eti C > m id L LL <br /> w <br /> Sample (r co b N C OI N m n N <br /> W c� Lll W J X <br /> z w Z 0 Q o _ _ _ o O O m 0. O m N <br /> Designation Date Time n = _ z m us m W <br /> 1 �6 <br /> M w 119:07 oZ <br /> 9 58 <br /> � -S SSS os <br /> M LV <br /> w <br /> Relinquished by Date Time Received by Remarks <br /> Relinq Date Time Received by <br /> Relinquished by ----- Date Time Received by Labor tory Bill to <br /> W L <br /> o s r J'� A <br /> Formslcoc 462801 fh9 <br /> Disinbution White-Lab, Yellow File,Pink-Onginator <br />