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ANALYTICAL 720 Olive Dive,suile D Lab: 916.297--800 <br /> t .0 Davis,CA 95616 Fas:91fi-?�17- 48{ln L �� ..] Page of <br /> Project Manager: Phone No.: <br /> T` Chain-of-Custody Record and Analysis Request <br /> ac,CNo <br /> Company/Address: FAX o.: r For Lab <br /> Analysis Request use Only <br /> Project Number: PO. No: Prol t Na e: W.E.T.(x) x <br /> 4 L 5�� G co <br /> o <br /> Project Location: Sampler S gn o TOTAL(x) <br /> CD <br /> Co <br /> ontainer Method 1 o 2 � ty <br /> Sampling (TypelAmount) Preserved Matrix �_ - 0 w N <br /> m <br /> O C7 o a a ti N <br /> U7 U7 CN <br /> O Q d � Q O O a O N -0L <br /> G7 <br /> LU Q' N N � co 0 <br /> co <br /> 7 J w l!7 f0 M O CO co m m <br /> Sample ¢ o w Z Q X 4 4 Q Q <br /> Designation o J a U z U o a a a rL a �, N <br /> Date Time 7 w � m T _ z m m w w w w w w U U <br /> l - kAA <br /> 6 <br /> I - T_ ' 0z <br /> o-3 <br /> TT <br /> Relinquishgd by Dale Time Received by: — Remarks. <br /> j p O (�16'� <br /> Re wished by: Date Time Received by: Email address: <br /> ❑.doc ❑.xis ❑.txt ❑other <br /> Relinquished by: Date Time Received by Laboratory: Bill to: <br /> UO <br /> Distribution: White-Lab, Yellow-File, Pink-Originator CiOC.th5 <br />