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• • • <br /> 720 Olive Drive, Suite D <br /> Davis,CA 95616 <br /> Lab 530 297 4800 nn `meq <br /> ANALYTICAL LLc Fax 530 297 4803 Lab No Page 2 of <br /> Project Manager . Phone No <br /> oA,- 7,o Chain-of-Custody Record and Analysis Request <br /> Company/Address FAX No <br /> )— I For Lab <br /> Analysts Request F use only <br /> Project Number P O No Email Address m <br /> p a n o v o <br /> � 0 0 F- <br /> pdf El As ❑ doc ❑other N t0 rD GO w en m yn <br /> Project Name/Location Sampler Signaturem a a 3 a ; <br /> N <br /> pN X C N M <br /> Container Met d w o w ; m , W <br /> Sampling (Type/Amount) Pre ed Matrix �2o Co W 0 O o N Q N N E E E E E <br /> °D S = to m C] m a o a <br /> O m '9 w y`� y�1 CO a7 <br /> 'LLJ 2 Om C'} rn rnIV MC ro >n H m O NSamLle m <br /> O Z <br /> z m W al �Designation a oO a N tl Nae Time (5 y ffYnI <br /> amC <br /> LL I <br /> Relinquished by Qate Time Received by Remarks <br /> Relinquished by Date <br /> Relinquished by Date Time Receive by ab ratory <br /> -------------- <br /> Distribution White-Lab,Yellow-File,Pink-Originator <br /> COC th8(5/00) <br />