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2795 2nd Street, Suite 300 <br /> /FFLab:Davis,30.297.4800 <br /> ANALYT/CAL LLC Fax: 530.297.4808 Lab No. 3 Page of <br /> Project Contact(Hardcopy or PDF To): California EDF Report? Yes L]No <br /> Chain-of-Custody Record and Analysis Request <br /> 1 -3 <br /> C any/Addres y � � butnot manctakuy to COffWkft#6$SCbn; <br /> /lv4,��� C�'� �i�Gf�Z� Sampling Company Log Code: Analysis Request � <br /> Phone No.: FAX No.: Global ID: m x <br /> a w . <br /> Project Number: P.O.No: EDF Deliverable To(Email Address): �_ ° ° m o <br /> m o w w o CD <br /> 04 x c <br /> N N N co ..! Q <br /> Project Name: Samp ign re: n Q m <br /> ClJi� � �iu``(• W m w m m mo W m <br /> o g m C7 C7 mo to Q m y M <br /> F- N U c <br /> Project Address: a a N S o ego <br /> 3S �Y Sampling ntai r Preservative Matrix m o N Ik-N �? y cm <br /> v V 1, <br /> N a= ILL <br /> O m m m m p N p <br /> Sample Designation Date Time v n = _ L) z rn w X -T r l t, � 16 Q <br /> W O m m H F a O O O O � w > d <br /> t 2 <br /> 3— <br /> tl <br /> 3o 12-, <br /> TF -+ 4 <br /> I-------71� _to <br /> Relinquished by: D Time Received by: Remarks: <br /> aQ►2 <br /> M <br /> b D e Time Received by: <br /> by- Date Time Received by Laboratory: -(;F Bill to: <br /> 17-12,03 1 CR 17- <br /> Distribution: <br /> zDistribution: White-Lab, Pink-Originator Forms/coc 1210011h9 <br />