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2795 2nd Street,Suite 300 <br /> /FF Davis,CA 95616 <br /> ANALYT/CAL <br /> Lab <br /> � 530 297 4800 / /f� <br /> Fax 530 297 4808 Lab No �//y f Page--,/—of <br /> Project Contact(Hardcopy or PDF To) California EDF Reports Yes ❑No <br /> Chain-of-Custody Record and Analysis Request <br /> Company/Adiffessputs <br /> �� Sampling Company Log Code 14/ Analysis Request <br /> Phone No FAXNo Glo al tD <br /> d C,22 r� m mo c`O+ r <br /> W <br /> Project Number P NoEDF Deliverable To(Small Address) - 9 m m m 3 T <br /> r <br /> Project Name SamplCd 0 <br /> Signa re n in m a Q _ <br /> UJ in 0 U `"@a CO ,d WXle O � a <br /> yp <br /> iP ACJ '"f' o40 <br /> S7 o N (a1 '^ L <br /> Protect Address EL a N W a - N <br /> �Sampling Container Preservative Matrix t t m � N {� M C <br /> do <br /> L Q m N N l0 h u v V N V L <br /> > �(1rl O sod: 0 ID <br /> eN� C C C = fV .~C LL. <br /> [ E LU O Z F" J X N N V' T T to p N <br /> x x <br /> Sample Designation Date Time v i = z c°n m m o 0 0 <br /> UJ <br /> 3 <br /> 710 <br /> _as <br /> ✓J�G� o _06 <br /> J!.f:Z4L1 219 >C —V11 <br /> a _4 <br /> �vM1. X N r o <br /> Relinquished b PDate Time Received by Remarks <br /> 7MIr eC <br /> Rehnqutshed b to Time Received by <br /> Date <br /> ,S TM1w 6 3 <br /> Relinquished by Date Time Received by Lab a <br /> ol/1,7 AO <br /> astnbution White-Lab, Pink-Origmalor Formslcoc 121001 fh9 <br />