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720 Olive Drive, Suite D / <br /> .�� Davis,CA 95616 <br /> Lab 530 297 4800 <br /> ANALYTICAL LLc Fax 530 297 4803 Lab leo Page l ofj <br /> Project Manager Phone No <br /> TO e CSR V4 a e 9lb 3� _ 3,1 S � Chain-of-Custody Record and Analysis Request <br /> Company/Address FAX No For Lab <br /> c q l 33 - Analysis Request Use Only <br /> Protect Number P O No Protect Name �, o � WET (x} Y <br /> tJ'k hal s G-.q s S f��t L w S v N <br /> TOTAL txy <br /> Protect Location Sampler Signature o <br /> lig E.C�n �t�r W�, StoC ew _ w <br /> W 1(1 H 0 <br /> Container Method h <br /> Sampling (TypelAmount) Preserved Matrix N g o C a. 00 m z m <br /> i N N N N C) <br /> Sample _ o W w 0 M �, m m N <br /> W Z ¢ p �o v <br /> o � U z 4 t- x a=- a a v a <br /> Designation Date Time � rn _ 1 z 3 m m r N w W v r <br /> M\ w x _b <br /> MW ' io�5 x x W <br /> 02.. <br /> Relinquished by Date Time Received by Remarks t4vti r i w1 P it ov4f h <br /> Mw -1 i"\w-3 Kw~Z) <br /> Relinquished by Date Time Received by Email address <br /> -- _ -_-_ — <br /> ❑ doc ❑ As ❑ txl ❑other <br /> Relinquished by Date Time Received by Laborato Bill to W rff4t Eyvtrc q pA f qqj (w) 833 -mi <br /> '12d'01:9 , , , yam > �I F. lot" s1 TV'a C- 9 01-� <br /> COC the(8198) <br /> Distabuhon White-Lab Yellow-File,Pink-Onginator <br />