Laserfiche WebLink
2795 2nd Street, Suite 300 <br /> Jrj� <br /> � Davis,CA 95616 <br /> NALYTICAL ccc Lab' 530 297 4800 <br /> Fax 530 297 4808 Lab No Page�of„�„ <br /> Protect Contact(Hardcopy or PDF To) California EDF Report? ® Yes ❑No <br /> 1 Chain-of-Custody Record and Analysis Request <br /> Companyh ddress but not T2ngM to u*s8cftm <br /> F�� Sampling Company Log Cods <br /> Phone No �r-� r` '�' >n `� '- Analysis Request <br /> FAX No Global ID <br /> a 7 -G•' �• a d✓ �� " l •� o CO t! <br /> 0 CO <br /> Project Number PO NoEDF Deliverable To(Email Address) o 0 0o m <br /> Project Name Sampler Signature $ �; m m Cli w ¢ 3 0 <br /> .C..rrr t' 7 w u, m w W m c oa w � y <br /> Project Address m _ x x m v Q c ti <br /> 5amphng Container Preserva ve Matrix o C �, ; J <br /> . .I <br /> ti {p <br /> � N N N 'd" .r... v U � CO <br /> ,� ! a0 N y m o m p <br /> j r.'SJR >_ > O w aci m m Qy 2 v r 1L <br /> Date TimeE ui <br /> Sample Designation 0 LU Z F <br /> = z w- mmrio rm r, ` a <br /> 1-- lo r- L. <br /> m p <br /> t <br /> 3 <br /> IT <br /> 41,a- Veaa <br /> r t � y <br /> i <br /> i <br /> FT1 <br /> Reiinquished by DateTime Received by Remarks } <br /> Relinquished by Date Time Received by L <br />" Relinquished b Date <br /> �py riime Re Iv b La tory Bill to <br /> zI V Z l] <br /> Dfstrfbutron White-Lai,Yellow-Fmp,Pink-Onginator <br /> - Forms/coo 121001 th9 <br />