Laserfiche WebLink
• • s <br /> 720 Olive Drive,Suite D - <br /> .�� Davis,CA 95818 � <br /> Lab 530 297 4800 <br /> ANALYTICAL LLc Fax 530 297 4803 Lab No ! ff Page of <br /> Protect Manager Phone No <br /> 1-4t Kqm 9 t4) 3 5 q- 3 Z 5a Chain-of-Custody Record and Analysis Request <br /> Company/Address FAX No t— For Lab <br /> (9 i b) W4— if 8{ Analysis Request use only <br /> Protect Number PO No Project Name r ia W r_T AXI y <br /> `�1�- I tLf4hD�s VAS S�k b rY w m 00( a <br /> W ill <br /> TOTAL{XJ <br /> Protect Location Sampler Signature N r' <br /> E, Cho ttt Ww to G1Ctoh, 1 <br /> a 0 M <br /> W 0 N <br /> Container Method 0 2 _ .. <br /> Sampling (TypelAmountt Preserved Matrix N o C t v m N z to m <br /> _1D ll <br /> N y 0) <br /> X X U a <br /> Sample E W o p U z w O ¢ rW- 0. a 0 0 V 0 a. a a T <br /> Designation Date Time n z = v z m m F- � " W LU -Jv �" <br /> CPTI - `DOCrW 4[ISIOD14(5 41 Ix W I IX X X "J( <br /> CPT i - 65 1500 i 1 1 A <br /> COY [ -N tris I X 5 x X X -©� <br /> C VT I T , X5+ 5 i S X X X <br /> A-L <br /> Relinquished by Date Time Received by Remarks <br /> L <br /> Re1,nqu,shed by Date Time Received by Email address <br /> ❑ doc ❑ xis ❑ txt ❑other <br /> Relinquished by ,Date Time Received by Laboratory Bill to WofW t4vilrow4ohl <br /> o t 14th SttTracy� CA 953-f6 <br /> �-Distnbution White-Lab yellow-Fite Pink-0nginator ' COC the{s198) <br />