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2795 2nd Street, Suite 300 <br /> /FF Davis,CA 95616 <br /> Lab: 530.297.4800 1 <br /> ANALYT/CAL LLC Fax: 530.297.4808 Lab No. 3(O�Z` Page of <br /> Project Contact(Hardcopy or PDF To): CallfOfllla EDF R@pOft� 1 Yes U No <br /> Chain-of-Custody Record and Analysis Request <br /> Comp y Address: section:�but riot nurdattify to complete this <br /> Sampling Company Log Code: Analysis Request Q <br /> t— <br /> Phone <br /> /No.: FAX <br /> /Noo.: +� (' Global ID: _ o <br /> CD O N 1- <br /> co co W <br /> Project Number: P.O.No: EDF Deliverable To(Email Address): `✓ mo >. <br /> F- F- W o <br /> Project Name: Sa r ig re: `� 20m m a m <br /> aD ; m = 2 co N U c <br /> Project Address: � — A A " m � <br /> Sampling ntainer Preservative Matrix l� o t, 0N = W °i -J <br /> D 6 m 6 N c0 C > m a U. <br /> 0 <br /> W W J ~ m C7 a, a T U) CD dtip 0 C <br /> x x x m Q <br /> Sample Designation Date Time of z ? U O F F a o 0 o O J w m>° <br /> 011 <br /> 12 <br /> Relinq ' y: Date Time Received by: Remarks: <br /> o4�Z <br /> R ups d y. Dat ime Received by: <br /> Relinquis by: Date Time Received by Laboratory: K-� Bill to: <br /> Distribution: White-Lab, Pink-Originator Forms/coc 121001.fh9 <br />