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No of -on W. , 1W a-IIIIIIIIIIIIII owl IW �Ir IMI111111 <br /> 720 Olive Drive,Suite D <br /> FF Davis,CA 95616 <br /> Lab 530 297 4800 Lab No Page I of I <br /> ANALYTICAL LL c Fax 530 297 4803 <br /> Project Manager Phone No <br /> To (9 1 6 13 5 4 - 3 x 5 o Chain-of-Custody Record and Analysis Request <br /> Company/Address FAX No r For Lab <br /> q <br /> rumbe=r <br /> vw, e1b) 3S 4— !I-$ 4 Analysis Request F use Only <br /> ProteP O Na Protect Name �, o � <br /> WET(x) <br /> S to f (►t d's Gas S 1g�t'�w Co o S S <br /> TOTAL(X) Y <br /> Protect Location Sampler Signature <br /> I'} 14 jr, Ck'k1-ttt► Way St9Fhtaw w U ro 2 <br /> Container Method <br /> 0Qo x CO to .. <br /> Sampling (Type/Amount) Preserved Matrix g o n a v z r <br /> -� 8 N L � rtN N yl CO C r <br /> Q {n N m 47 d Ql N O N a N <br /> C7 � � �n m p� N N � <br /> Sample 5 E 0 W W Co <br /> E W C7 U z W 0 ¢ >- a a r0 0 0 a a v N <br /> Designation Date Time - i � � z = 0 z � m m � '` LO r- "' r LU � � <br /> Mw-I t3 99 1010 It x X W X K D <br /> MW- 3 toto x x w x x 0� <br /> Mw - Z Io3a 4 x vJ X X 43 <br /> Reli cashed by Date Time Receiv d by Remarks Nat@ S4"F lis O1-df r 5,eS k t HCB <br /> -+' 3(991z30 klr� (Mw-1, Mw •31 Mw-2) <br /> Felinqu'ished <br /> y Date Time Received by Email address <br /> ❑ doc EJ As ❑ txt ❑other <br /> y Date Time Received by Laboratory 13111 to W ri q kt f kv i ro n"t��i 20 9)$33`0}9 9 <br /> b} E- 104h St , Tlracy "4 Ktriq. <br /> COC fhb(9198) <br /> Distnbution White-Lab Yellow-File Pink-Onginetor <br /> I <br />